A prospective study to evaluate the utility of blood culture in hospitalized children with community acquired pneumonia (age three months to eighteen years)
DOI:
https://doi.org/10.18203/2349-3291.ijcp20261893Keywords:
Community-acquired pneumonia, Blood culture, Bacteremia, Paediatric infection, Streptococcus pneumoniae, Survival analysisAbstract
Background: Community-acquired pneumonia (CAP) remains a leading cause of morbidity and mortality among children worldwide. Although blood culture is the diagnostic gold standard for bacteremia, its routine use in paediatric CAP is debated due to low yield and contamination risk. To evaluate the diagnostic and prognostic utility of blood culture in hospitalized children with CAP.
Methods: A prospective analytical study was conducted among 100 children aged 3 months-18 years admitted with CAP at GBH General Hospital, AIIMS Udaipur (January 2023-July 2025). Demographic, clinical, laboratory and radiological data were recorded. Blood cultures were obtained before antibiotic therapy and processed using standard microbiological methods. Associations between culture results and outcomes were analysed using SPSS v25 (p<0.05).
Results: Blood culture was positive in 22% of cases, with Streptococcus pneumoniae as the predominant isolate (45.5%). Positive cultures were significantly associated with ICU admission (81.8%), complications (31.8%), antibiotic escalation (81.8%) and mortality (36.4%) (p<0.001). Kaplan–Meier survival analysis showed markedly lower survival among culture-positive patients (63.6%) compared to culture-negative (98.7%, p<0.001).
Conclusions: Blood culture positivity in pediatric CAP signifies severe disease and adverse outcomes. Selective use in moderate-to-severe cases can guide rational antibiotic therapy and improve prognostic assessment.
References
Troeger C, Blacker B, Khalil IA, Rao PC, Cao J, Zimsen SRM, et al. GBD 2016 Lower Respiratory Infections Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis. 2018;18(11):1191-210.
Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H. Epidemiology and etiology of childhood pneumonia. Bull World Health Organ. 2008;86(5):408-16.
Shi T, McAllister DA, O'Brien KL, Simoes EAF, Madhi SA, Gessner BD, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. Lancet. 2017;390(10098):946-58.
Jain S, Williams DJ, Arnold SR, Ampofo K, Bramley AM, Reed C, et al. Community-acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med. 2015;372(9):835-45.
Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25-76.
Laxminarayan R, Chaudhury RR. Antibiotic resistance in India: drivers and opportunities for action. PLoS Med. 2016;13(3):e1001974.
Iroh Tam PY, Bernstein E, Ma X, Ferrieri P. Blood culture in evaluation of pediatric community-acquired pneumonia: a systematic review and meta-analysis. Hosp Pediatr. 2015;5(6):324-36.
McCulloh RJ, Koster MP, Yin DE, Milner TL, Ralston SL, Hill VL, et al. Evaluating the use of blood cultures in the management of children hospitalized for community-acquired pneumonia. PLoS One. 2015;10(2):e0117462.
Neuman MI, Hall M, Lipsett SC, Hersh AL, Williams DJ, Gerber JS, et al. Utility of blood culture among children hospitalized with community-acquired pneumonia. Pediatrics. 2017;140(3):e20171013.
Kwon JH, Kim JH, Lee JY, Kim YJ, Sohn CH, Lim KS, et al. Low utility of blood culture in pediatric community-acquired pneumonia: an observational study on 2705 patients admitted to the emergency department. Medicine (Baltimore). 2017;96(22):e7028.
McCulloh RJ, Koster MP, Yin DE, Milner TL, Ralston SL, Hill VL, et al. Evaluating the use of blood cultures in the management of children hospitalized for community-acquired pneumonia. PLoS One. 2015;10(2):e0117462.
Youssef AS, Fanous M, Siddiqui FJ, Estrada J, Chorny V, Braiman M, et al. Value of blood cultures in the management of children hospitalized with community-acquired pneumonia. Cureus. 2020;12(5):e8196.
Lima GV, Leite RR, Oliveira SMDA, Gomes SMB, Ferreira SB. The microbiological profile of community-acquired pneumonia in pediatric patients in Brazil. Arch Clin Infect Dis. 2023;18(2):e136520.
Chi H, Huang YC, Liu CC, Chang KY, Huang YC, Lin HC, et al. Characteristics and etiology of hospitalized pediatric community-acquired pneumonia in Taiwan. J Formos Med Assoc. 2020;119(10):1490-9.
Verma N, Gupta P, Pandey AK, Awasthi S. Nasopharyngeal carriage of Streptococcus pneumoniae serotypes among sick and healthy children in northern India: a case-control study. Vaccine. 2023;41(44):6619-24.
Ugleva T, Ushakova O. Symptoms and clinical data of community-acquired pneumonia in children. Vestnik Surgut State University. Medicine. 2023;4:10.
Dahy M, Shoriet AH, Askar EAR. Clinical audit on management of community-acquired pneumonia in pediatric intensive care unit. J Pediatr Care. 2017;3(3):1000136.
Davies HD. Community-acquired pneumonia in children. Paediatr Child Health. 2003;8(10):616-9.
Fritz CQ, Edwards KM, Self WH, Grijalva CG, Zhu Y, Arnold SR, et al. Prevalence, risk factors, and outcomes of bacteremic pneumonia in children. Pediatrics. 2019;144(1):e20183090.
Williams DJ. Do all children hospitalized with community-acquired pneumonia require blood cultures?. Hosp Pediatr. 2013;3(2):177-9.
Iqbal MS, Khan MW, Ramly B, Agrawal P, Khan A. P157 Role of blood culture in childhood community acquired pneumonia. In: Abstracts. BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health; 2019:220.
Heine D, Cochran C, Moore M, Titus MO, Andrews AL. The prevalence of bacteremia in pediatric patients with community-acquired pneumonia: guidelines to reduce the frequency of obtaining blood cultures. Hosp Pediatr. 2013;3(2):92-6.
Shah SS, Dugan MH, Bell LM, Grundmeier RW, Florin TA, Hines EM, et al. Blood cultures in the emergency department evaluation of childhood pneumonia. Pediatr Infect Dis J. 2011;30(6):475-9.