Evaluating the use of blood cultures in the management of children hospitalized for community-acquired pneumonia

Russell J. McCulloh, Michael P. Koster, Dwight E. Yin, Tiffany L. Milner, Shawn L. Ralston, Vanessa L. Hill, Brian K. Alverson, Eric Biondi

Research output: Contribution to journalArticle

Abstract

Background: Blood cultures are often recommended for the evaluation of community-acquired pneumonia (CAP). However, institutions vary in their use of blood cultures, and blood cultures have unclear utility in CAP management in hospitalized children. Objective: To identify clinical factors associated with obtaining blood cultures in children hospitalized with CAP, and to estimate the association between blood culture obtainment and hospital length of stay (LOS). Methods: We performed a multicenter retrospective cohort study of children admitted with a diagnosis of CAP to any of four pediatric hospitals in the United States from January 1, 2011-December 31, 2012. Demographics, medical history, diagnostic testing, and clinical outcomes were abstracted via manual chart review. Multivariable logistic regression evaluated patient and clinical factors for associations with obtaining blood cultures. Propensity score-matched Kaplan-Meier analysis compared patients with and without blood cultures for hospital LOS. Results: Six hundred fourteen charts met inclusion criteria; 390 children had blood cultures obtained. Of children with blood cultures, six (1.5%) were positive for a pathogen and nine (2.3%) grew a contaminant. Factors associated with blood culture obtainment included presenting with symptoms of systemic inflammatory response syndrome (OR 1.78, 95%CI 1.10-2.89), receiving intravenous hydration (OR 3.94, 95% CI 3.22-4.83), receiving antibiotics before admission (OR 1.49, 95% CI 1.17-1.89), hospital admission fromthe ED (OR 1.65, 95%CI 1.05-2.60), and having health insurance (OR 0.42, 95%CI 0.30-0.60). In propensity score-matched analysis, patients with blood cultures hadmedian 0.8 days longer LOS (2.0 vs 1.2 days, P < .0001) without increased odds of readmission (OR 0.94, 95% CI 0.45-1.97) or death (P = .25). Conclusions: Obtaining blood cultures in children hospitalized with CAP rarely identifies a causative pathogen and is associated with increased LOS. Our results highlight the need to refine the role of obtaining blood cultures in children hospitalized with CAP.

Original languageEnglish (US)
Article numbere0117462
JournalPLoS One
Volume10
Issue number2
DOIs
StatePublished - Feb 6 2015
Externally publishedYes

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Hospitalized Child
pneumonia
Pneumonia
Blood
blood
Length of Stay
Propensity Score
Pathogens
Blood Culture
Health insurance
health insurance
medical history
Systemic Inflammatory Response Syndrome
Pediatrics
Pediatric Hospitals
pathogens
Kaplan-Meier Estimate
Health Insurance
cohort studies
Hydration

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Evaluating the use of blood cultures in the management of children hospitalized for community-acquired pneumonia. / McCulloh, Russell J.; Koster, Michael P.; Yin, Dwight E.; Milner, Tiffany L.; Ralston, Shawn L.; Hill, Vanessa L.; Alverson, Brian K.; Biondi, Eric.

In: PLoS One, Vol. 10, No. 2, e0117462, 06.02.2015.

Research output: Contribution to journalArticle

McCulloh, RJ, Koster, MP, Yin, DE, Milner, TL, Ralston, SL, Hill, VL, Alverson, BK & Biondi, E 2015, 'Evaluating the use of blood cultures in the management of children hospitalized for community-acquired pneumonia', PLoS One, vol. 10, no. 2, e0117462. https://doi.org/10.1371/journal.pone.0117462
McCulloh, Russell J. ; Koster, Michael P. ; Yin, Dwight E. ; Milner, Tiffany L. ; Ralston, Shawn L. ; Hill, Vanessa L. ; Alverson, Brian K. ; Biondi, Eric. / Evaluating the use of blood cultures in the management of children hospitalized for community-acquired pneumonia. In: PLoS One. 2015 ; Vol. 10, No. 2.
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abstract = "Background: Blood cultures are often recommended for the evaluation of community-acquired pneumonia (CAP). However, institutions vary in their use of blood cultures, and blood cultures have unclear utility in CAP management in hospitalized children. Objective: To identify clinical factors associated with obtaining blood cultures in children hospitalized with CAP, and to estimate the association between blood culture obtainment and hospital length of stay (LOS). Methods: We performed a multicenter retrospective cohort study of children admitted with a diagnosis of CAP to any of four pediatric hospitals in the United States from January 1, 2011-December 31, 2012. Demographics, medical history, diagnostic testing, and clinical outcomes were abstracted via manual chart review. Multivariable logistic regression evaluated patient and clinical factors for associations with obtaining blood cultures. Propensity score-matched Kaplan-Meier analysis compared patients with and without blood cultures for hospital LOS. Results: Six hundred fourteen charts met inclusion criteria; 390 children had blood cultures obtained. Of children with blood cultures, six (1.5{\%}) were positive for a pathogen and nine (2.3{\%}) grew a contaminant. Factors associated with blood culture obtainment included presenting with symptoms of systemic inflammatory response syndrome (OR 1.78, 95{\%}CI 1.10-2.89), receiving intravenous hydration (OR 3.94, 95{\%} CI 3.22-4.83), receiving antibiotics before admission (OR 1.49, 95{\%} CI 1.17-1.89), hospital admission fromthe ED (OR 1.65, 95{\%}CI 1.05-2.60), and having health insurance (OR 0.42, 95{\%}CI 0.30-0.60). In propensity score-matched analysis, patients with blood cultures hadmedian 0.8 days longer LOS (2.0 vs 1.2 days, P < .0001) without increased odds of readmission (OR 0.94, 95{\%} CI 0.45-1.97) or death (P = .25). Conclusions: Obtaining blood cultures in children hospitalized with CAP rarely identifies a causative pathogen and is associated with increased LOS. Our results highlight the need to refine the role of obtaining blood cultures in children hospitalized with CAP.",
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AU - McCulloh, Russell J.

AU - Koster, Michael P.

AU - Yin, Dwight E.

AU - Milner, Tiffany L.

AU - Ralston, Shawn L.

AU - Hill, Vanessa L.

AU - Alverson, Brian K.

AU - Biondi, Eric

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N2 - Background: Blood cultures are often recommended for the evaluation of community-acquired pneumonia (CAP). However, institutions vary in their use of blood cultures, and blood cultures have unclear utility in CAP management in hospitalized children. Objective: To identify clinical factors associated with obtaining blood cultures in children hospitalized with CAP, and to estimate the association between blood culture obtainment and hospital length of stay (LOS). Methods: We performed a multicenter retrospective cohort study of children admitted with a diagnosis of CAP to any of four pediatric hospitals in the United States from January 1, 2011-December 31, 2012. Demographics, medical history, diagnostic testing, and clinical outcomes were abstracted via manual chart review. Multivariable logistic regression evaluated patient and clinical factors for associations with obtaining blood cultures. Propensity score-matched Kaplan-Meier analysis compared patients with and without blood cultures for hospital LOS. Results: Six hundred fourteen charts met inclusion criteria; 390 children had blood cultures obtained. Of children with blood cultures, six (1.5%) were positive for a pathogen and nine (2.3%) grew a contaminant. Factors associated with blood culture obtainment included presenting with symptoms of systemic inflammatory response syndrome (OR 1.78, 95%CI 1.10-2.89), receiving intravenous hydration (OR 3.94, 95% CI 3.22-4.83), receiving antibiotics before admission (OR 1.49, 95% CI 1.17-1.89), hospital admission fromthe ED (OR 1.65, 95%CI 1.05-2.60), and having health insurance (OR 0.42, 95%CI 0.30-0.60). In propensity score-matched analysis, patients with blood cultures hadmedian 0.8 days longer LOS (2.0 vs 1.2 days, P < .0001) without increased odds of readmission (OR 0.94, 95% CI 0.45-1.97) or death (P = .25). Conclusions: Obtaining blood cultures in children hospitalized with CAP rarely identifies a causative pathogen and is associated with increased LOS. Our results highlight the need to refine the role of obtaining blood cultures in children hospitalized with CAP.

AB - Background: Blood cultures are often recommended for the evaluation of community-acquired pneumonia (CAP). However, institutions vary in their use of blood cultures, and blood cultures have unclear utility in CAP management in hospitalized children. Objective: To identify clinical factors associated with obtaining blood cultures in children hospitalized with CAP, and to estimate the association between blood culture obtainment and hospital length of stay (LOS). Methods: We performed a multicenter retrospective cohort study of children admitted with a diagnosis of CAP to any of four pediatric hospitals in the United States from January 1, 2011-December 31, 2012. Demographics, medical history, diagnostic testing, and clinical outcomes were abstracted via manual chart review. Multivariable logistic regression evaluated patient and clinical factors for associations with obtaining blood cultures. Propensity score-matched Kaplan-Meier analysis compared patients with and without blood cultures for hospital LOS. Results: Six hundred fourteen charts met inclusion criteria; 390 children had blood cultures obtained. Of children with blood cultures, six (1.5%) were positive for a pathogen and nine (2.3%) grew a contaminant. Factors associated with blood culture obtainment included presenting with symptoms of systemic inflammatory response syndrome (OR 1.78, 95%CI 1.10-2.89), receiving intravenous hydration (OR 3.94, 95% CI 3.22-4.83), receiving antibiotics before admission (OR 1.49, 95% CI 1.17-1.89), hospital admission fromthe ED (OR 1.65, 95%CI 1.05-2.60), and having health insurance (OR 0.42, 95%CI 0.30-0.60). In propensity score-matched analysis, patients with blood cultures hadmedian 0.8 days longer LOS (2.0 vs 1.2 days, P < .0001) without increased odds of readmission (OR 0.94, 95% CI 0.45-1.97) or death (P = .25). Conclusions: Obtaining blood cultures in children hospitalized with CAP rarely identifies a causative pathogen and is associated with increased LOS. Our results highlight the need to refine the role of obtaining blood cultures in children hospitalized with CAP.

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