title: Clinical and Laboratory Potential Predictors of Blood Culture Positivity in Under Five Children with Clinically Severe Pneumonia - Khartoum -Sudan.
abstract: BACKGROUND
  Blood culture is necessary for appropriate management of clinically severe pneumonia in children under five years of age. However, in limited resource countries it might be unduly costly and waste of valuable time because of the high negative culture rate.
  
  
  OBJECTIVE
  This study aims to identify clinical and laboratory parameters that potentially predict a positive blood culture in cases of severe pneumonia.
  
  
  METHODS
  A hospital based study, enrolled 189 cases satisfying the WHO definition of severe pneumonia. Age, gender, clinical history, physical examination, temperature, complete blood count, C-reactive protein, blood culture and Chest X Ray for all the patients were recorded.
  
  
  RESULTS
  Forty one patients had positive blood culture giving a prevalence of 21.7%. All variables were used in a dichotomous manner. White Blood Count (WBC) more than 20 000, very high C-reactive protein (C-RP ≥8mg/L) and Temperature more than 40(o)C, had a positive predictive value of 46.1%, 44.3% and 40.0% respectively for a positive culture as well as a Negative Predictive Value of 91.1%, 91.6% and 91.7% respectively. The WBC more than 20 000 and temperature above 40(o)C had a significant association with a positive blood culture. Their adjusted Odds Ratios were 3.9 (95% CI: 1.4-10.90) and 3.1 (95% CI: 1.2-8.4) respectively. This was not the case for C-RP (Odds Ratio=2.2, 95% CI: 0.7-2.2) or positive Chest X Ray (Odds Ratio=1.5, 95% CI: 0.6-3.6).
  
  
  CONCLUSIONS
  Temperature of more than 40(o)C, Very high C-RP and WBC of more than 20 000 are good indicators of a potential positive blood culture. It is therefore recommended that further research be undertaken to refine these predictors as screening tools before resorting to blood culture. It is also recommended that antibiotic treatment may be initiated on the basis of the high temperature and WBC, while waiting for the culture results.
authors.affiliation: Associate Professor, Deparment of Pediatrics, Bahri University, College of Medicine, Sudan and King Khalid University, College of Medicine , Abha, KSA .
authors.forename: Karimeldin Mohamed Ali
authors.initials: KM
authors.lastname: Salih
authors.affiliation: Professor, Deparment of Community Medicine & Epidemiology Department, Ahfad University for Women , Khartoum, Sudan .
authors.forename: El-Fatih
authors.initials: el-F
authors.lastname: El-Samani
authors.affiliation: Assistant Professor, Deparment of Pediatrics, Qassim University, College of Medicine , Buraydah, KSA .
authors.forename: Jalal Ali
authors.initials: JA
authors.lastname: Bilal
authors.affiliation: Consultant Pediatrician, Deparment of Pediatrics, Ministry of Health , Sudan .
authors.forename: Widad
authors.initials: W
authors.lastname: Eldouch
authors.affiliation: Professor, Deparment of Pediatrics, University of Khartoum, Faculty of Medicine , Sudan .
authors.forename: Salah Ahmed
authors.initials: SA
authors.lastname: Ibrahim
keywords: Blood culture; C-RP; Pneumonia; Severity; Temperature; WBC