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Obtaining blood culture for CAP linked to prolonged hospital stay, unnecessary antibiotic treatment
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SAN DIEGO — Children hospitalized with community-acquired pneumonia who had blood culture taken were more likely to have prolonged hospital stay and receive unnecessary antibiotic treatment, according to data presented at the 2014 AAP National Conference and Exhibition.
Michael P. Koster, MD, FAAP, of Hasbro Children’s Hospital in Providence, R.I., and colleagues assessed medical records of 763 children hospitalized with community-acquired pneumonia (CAP) between 2011 and 2012. Patients were aged 3 months to 18 years.
Michael P. Koster
“This study looked at if blood cultures offer much benefit in terms of changing management or improving care in children. We were particularly interested in this [Infectious Diseases Society of America] recommendation because it was a strong recommendation based on weak evidence. A lot of evidence that has come out since the recommendation in 2011 has suggested blood cultures don’t offer a whole lot of benefit,” Koster told Infectious Diseases in Children.
Patients with blood cultures (n=462) had longer lengths of stay compared with patients who did not have a blood culture taken (n=301), 3.4 days vs. 1.9 days (P<0.0001). This difference remained significant after removing ICU patients, 2.5 days vs. 1.8 days (P<0.0001).
In subsequent analysis, using a propensity-score matching system, there remained a median difference of 0.8 days in time to discharge between children who had a blood culture taken and those who did not have a blood culture taken (P<0.0001).
Patients who had blood cultures taken were more likely to receive a third generation cephalosporin compared with those who did not have a blood culture taken (68.9% vs. 42.9%; P<0.0001).
Researchers found no differences between patients with blood cultures and those without regarding receipt of antibiotics prior to presentation (41.6% vs. 40.9%), presence of pulmonary effusion (57.6% vs. 61.1%), or 14-day readmission rates (4.1% vs. 3%). There were no readmissions for bacteremia or sepsis among either group of children.
“We think that the recommendation to obtain blood cultures for all patients admitted with moderate to severe CAP needs to be revisited and graded in some way so that very sick patients or patients with effusions or empyema should get blood cultures, but your regular, healthy child coming in with pneumonia doesn’t need a blood culture. We think blood cultures will increase the length of stay and increase use of broad-spectrum antibiotics, which are unnecessary,” Koster said. — by Amanda Oldt
For more information:
Koster MP. #27291. Presented at: 2014 AAP National Conference and Exhibition; Oct. 11-14; San Diego.
Disclosure: Koster reported no relevant financial disclosures.
Perspective
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Samir S. Shah, MC, MSCE
The 2011 National Childhood Pneumonia Guidelines jointly published by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America recommend narrow-spectrum beta-lactam antibiotics such as amoxicillin and ampicillin as first-line treatment for children suspected of having uncomplicated bacterial pneumonia. While several hospital systems have implemented strategies to improve adherence to these national guideline recommendations, broad-spectrum antibiotic prescribing remains common.
The findings by Koster and colleagues indicate that despite the higher prevalence of narrow-spectrum antibiotic prescribing at discharge, broad-spectrum prescribing was distressingly common across all settings. Furthermore, broad-spectrum antibiotic prescribing in their study was especially common in the office and emergency department settings where most of the 1.5 million children with pneumonia each year receive treatment. While stewardship in the hospital setting is important, efforts to optimize antibiotic prescribing in outpatient settings are a critical component to reduce community-level antibiotic resistance and adverse drug events.
In this new era where hospitals and health systems are increasingly accountable for population-level health, hospital-based physicians must partner with providers across the spectrum of care to spearhead improvement effort. The publicly-available guidelines can be accessed at http://cid.oxfordjournals.org/content/53/7/e25.long.
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