PREVALENCE AND PREDICTORS OF BACTEREMIA AMONG CHILDREN HOSPITALIZED WITH PNEUMONIA.

ABSTRACT

National guidelines from many countries recommend obtaining blood culture from children with pneumonia upon hospitalization if the case is moderate to severe. However, etiological, microbes, and health systems vary by country and factors associated with bacteremia may also vary. We aimed to determine the prevalence and identify factors associated with bacteremia among children hospitalized with community-acquired pneumonia (CAP) in Thailand. We conducted a prospective descriptive study. The study population was children aged 60 days to 15 years hospitalized with CAP at King Chulalongkorn Memorial Hospital, Bangkok, Thailand from June 2014 to April 2015. We compared subject with positive and negative blood cultures. One hundred fifty-two children with CAP were recruited. Thirteen cases (8.6%) had a positive blood culture; 7 cases (4.6%) with a positive blood culture were considered contamination, leaving 6 (3.9%) true positive cases. The isolated organisms were Streptococcus pneumoniae, Escherichia coli, and Salmonella group B. Five factors were found to be associated with bacteremia 1) body temperature >38.5°C [odds ratio (OR) = 9], 2) severe sepsis status (OR = 27), 3) severe respiratory distress requiring mechanical ventilation (OR = 145), 4) leukocytosis >17,000/µl (OR = 6), and 5) patchy infiltration (OR=13). Children hospitalized with community acquired pneumonia have a low rate of bacteremia. The prevalence of subjects in our study with bacteremia was 3.9% and there were 3 clinical and 2 laboratory factors significantly associated with bacteremia. This study shows that hemoculture do not need to be routinely performed in all children hospitalized with CAP.