In the Journals

Bacteremic CAP uncommon in kids

Bacteremia is uncommon among children hospitalized with community-acquired pneumonia, or CAP, according to a study published in Pediatrics. However, bacteremic children with CAP tended to have more severe disease.

Researchers further suggested that blood cultures may not be appropriate for all children, but they may have a greater use in those with parapneumonic effusion and ICU admission.

“The potential benefits of positive blood culture results in CAP patients include the ability to narrow antibiotic spectrum, predict outcomes and inform assessments of vaccine efficacy; but the yield and impact of blood cultures have not been adequately studied,” Cristin Q. Fritz, MD, MPH, a pediatric resident at Vanderbilt University Medical Center, and colleagues wrote.

Fritz and colleagues noted that the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America guideline recommends routine blood cultures for most children hospitalized with CAP, but the effect of routine blood cultures in all hospitalized children with pneumonia is unclear.

The researchers analyzed data from hospitalized children aged younger than 18 years who had pneumonia and were enrolled in the Etiology of Pneumonia in the Community (EPIC) study between January 2010 and June 2012. Of the 2,358 children included in the study, 91% had a blood culture. Bacteremia was identified in 2.2% of these children.

When children did have bacteremia, the researchers most commonly observed Streptococcus pneumoniae (n = 23; 50%), Staphylococcus aureus (n = 6; 13%) and Streptococcus pyogenes (n = 4; 9%).

Children with bacteremia were significantly more likely to be male and have parapneumonic effusion but were significantly less likely to have chest indrawing or wheezing or to have previously received antibiotics. Negative outcomes were more common among children with bacteremia, including longer lengths of stay (median = 5.8 vs. 2.8 days; adjusted HR = 0.79; 95% CI, 0.73-0.86), increased risk for ICU admission (43% vs. 21%; aOR = 5.21; 95% CI, 3.82-6.84) and invasive mechanical ventilation or shock (30% vs. 8%; aOR = 5.28; 95% CI, 2.41-11.57).

Fritz and colleagues wrote that most children with bacteremic pneumonia were prescribed broad-spectrum, empirical antibiotics. Two-thirds of these patients were later prescribed more narrow-spectrum antibiotics after the bacteremia causing the infection had been identified.

The researchers noted that most pathogens recovered from children with bacteremic CAP were susceptible to penicillin, which is consistent with previous research. Taken together, these studies support the PIDS and IDSA guideline recommending the use of narrow-spectrum aminopenicillins in children hospitalized with suspected bacterial CAP, they said. – by Katherine Bortz

References:

Bradley JS, et al. Clin Infect Dis. 2011;doi:10.1093/cid/cir625.

Fritz CQ, et al. Pediatrics. 2019;doi:10.1542/peds.2018-3090.

Disclosures: Fritz reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Bacteremia is uncommon among children hospitalized with community-acquired pneumonia, or CAP, according to a study published in Pediatrics. However, bacteremic children with CAP tended to have more severe disease.

Researchers further suggested that blood cultures may not be appropriate for all children, but they may have a greater use in those with parapneumonic effusion and ICU admission.

“The potential benefits of positive blood culture results in CAP patients include the ability to narrow antibiotic spectrum, predict outcomes and inform assessments of vaccine efficacy; but the yield and impact of blood cultures have not been adequately studied,” Cristin Q. Fritz, MD, MPH, a pediatric resident at Vanderbilt University Medical Center, and colleagues wrote.

Fritz and colleagues noted that the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America guideline recommends routine blood cultures for most children hospitalized with CAP, but the effect of routine blood cultures in all hospitalized children with pneumonia is unclear.

The researchers analyzed data from hospitalized children aged younger than 18 years who had pneumonia and were enrolled in the Etiology of Pneumonia in the Community (EPIC) study between January 2010 and June 2012. Of the 2,358 children included in the study, 91% had a blood culture. Bacteremia was identified in 2.2% of these children.

When children did have bacteremia, the researchers most commonly observed Streptococcus pneumoniae (n = 23; 50%), Staphylococcus aureus (n = 6; 13%) and Streptococcus pyogenes (n = 4; 9%).

Children with bacteremia were significantly more likely to be male and have parapneumonic effusion but were significantly less likely to have chest indrawing or wheezing or to have previously received antibiotics. Negative outcomes were more common among children with bacteremia, including longer lengths of stay (median = 5.8 vs. 2.8 days; adjusted HR = 0.79; 95% CI, 0.73-0.86), increased risk for ICU admission (43% vs. 21%; aOR = 5.21; 95% CI, 3.82-6.84) and invasive mechanical ventilation or shock (30% vs. 8%; aOR = 5.28; 95% CI, 2.41-11.57).

Fritz and colleagues wrote that most children with bacteremic pneumonia were prescribed broad-spectrum, empirical antibiotics. Two-thirds of these patients were later prescribed more narrow-spectrum antibiotics after the bacteremia causing the infection had been identified.

The researchers noted that most pathogens recovered from children with bacteremic CAP were susceptible to penicillin, which is consistent with previous research. Taken together, these studies support the PIDS and IDSA guideline recommending the use of narrow-spectrum aminopenicillins in children hospitalized with suspected bacterial CAP, they said. – by Katherine Bortz

References:

Bradley JS, et al. Clin Infect Dis. 2011;doi:10.1093/cid/cir625.

Fritz CQ, et al. Pediatrics. 2019;doi:10.1542/peds.2018-3090.

Disclosures: Fritz reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.