Prevalence, risk factors, and outcomes of bacteremic pneumonia in children

Cristin Q. Fritz*, Kathryn M. Edwards, Wesley H. Self, Carlos G. Grijalva, Yuwei Zhu, Sandra R. Arnold, Jonathan A. McCullers, Krow Ampofo, Andrew T. Pavia, Richard G Wunderink, Evan J. Anderson, Anna M. Bramley, Seema Jain, Derek J. Williams

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Previous studies examining bacteremia in hospitalized children with pneumonia are limited by incomplete culture data. We sought to determine characteristics of children with bacteremic pneumonia using data from a large prospective study with systematic blood culturing. METHODS: Children <18 years hospitalized with pneumonia and enrolled in the multicenter Etiology of Pneumonia in the Community study between January 2010 and June 2012 were eligible. Bivariate comparisons were used to identify factors associated with bacteremia. Associations between bacteremia and clinical outcomes were assessed by using Cox proportional hazards regression for length of stay and logistic regression for ICU admission and invasive mechanical ventilation or shock. RESULTS: Blood cultures were obtained in 2143 (91%) of 2358 children; 46 (2.2%) had bacteremia. The most common pathogens were Streptococcus pneumoniae (n = 23, 50%), Staphylococcus aureus (n = 6, 13%), and Streptococcus pyogenes (n = 4, 9%). Characteristics associated with bacteremia included male sex, parapneumonic effusion, lack of chest indrawing or wheezing, and no previous receipt of antibiotics. Children with bacteremia had longer lengths of stay (median: 5.8 vs 2.8 days; adjusted hazard ratio: 0.79 [0.73-0.86]) and increased odds of ICU admission (43% vs 21%; adjusted odds ratio: 5.21 [3.82-6.84]) and invasive mechanical ventilation or shock (30% vs 8%; adjusted odds ratio: 5.28 [2.41-11.57]). CONCLUSIONS: Bacteremia was uncommonly detected in this large multicenter cohort of children hospitalized with community-acquired pneumonia but was associated with severe disease. S pneumoniae was detected most often. Blood culture was of low yield in general but may have greater use in those with parapneumonic effusion and ICU admission.

Original languageEnglish (US)
Article numbere20183090
JournalPediatrics
Volume144
Issue number1
DOIs
StatePublished - Jan 1 2019

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Bacteremia
Pneumonia
Hospitalized Child
Artificial Respiration
Shock
Length of Stay
Odds Ratio
Streptococcus pyogenes
Respiratory Sounds
Streptococcus pneumoniae
Staphylococcus aureus
Thorax
Logistic Models
Prospective Studies
Anti-Bacterial Agents

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Fritz, C. Q., Edwards, K. M., Self, W. H., Grijalva, C. G., Zhu, Y., Arnold, S. R., ... Williams, D. J. (2019). Prevalence, risk factors, and outcomes of bacteremic pneumonia in children. Pediatrics, 144(1), [e20183090]. https://doi.org/10.1542/peds.2018-3090
Fritz, Cristin Q. ; Edwards, Kathryn M. ; Self, Wesley H. ; Grijalva, Carlos G. ; Zhu, Yuwei ; Arnold, Sandra R. ; McCullers, Jonathan A. ; Ampofo, Krow ; Pavia, Andrew T. ; Wunderink, Richard G ; Anderson, Evan J. ; Bramley, Anna M. ; Jain, Seema ; Williams, Derek J. / Prevalence, risk factors, and outcomes of bacteremic pneumonia in children. In: Pediatrics. 2019 ; Vol. 144, No. 1.
@article{c87ac9a3d1fc4a0bbabc33739c26ed6b,
title = "Prevalence, risk factors, and outcomes of bacteremic pneumonia in children",
abstract = "BACKGROUND: Previous studies examining bacteremia in hospitalized children with pneumonia are limited by incomplete culture data. We sought to determine characteristics of children with bacteremic pneumonia using data from a large prospective study with systematic blood culturing. METHODS: Children <18 years hospitalized with pneumonia and enrolled in the multicenter Etiology of Pneumonia in the Community study between January 2010 and June 2012 were eligible. Bivariate comparisons were used to identify factors associated with bacteremia. Associations between bacteremia and clinical outcomes were assessed by using Cox proportional hazards regression for length of stay and logistic regression for ICU admission and invasive mechanical ventilation or shock. RESULTS: Blood cultures were obtained in 2143 (91{\%}) of 2358 children; 46 (2.2{\%}) had bacteremia. The most common pathogens were Streptococcus pneumoniae (n = 23, 50{\%}), Staphylococcus aureus (n = 6, 13{\%}), and Streptococcus pyogenes (n = 4, 9{\%}). Characteristics associated with bacteremia included male sex, parapneumonic effusion, lack of chest indrawing or wheezing, and no previous receipt of antibiotics. Children with bacteremia had longer lengths of stay (median: 5.8 vs 2.8 days; adjusted hazard ratio: 0.79 [0.73-0.86]) and increased odds of ICU admission (43{\%} vs 21{\%}; adjusted odds ratio: 5.21 [3.82-6.84]) and invasive mechanical ventilation or shock (30{\%} vs 8{\%}; adjusted odds ratio: 5.28 [2.41-11.57]). CONCLUSIONS: Bacteremia was uncommonly detected in this large multicenter cohort of children hospitalized with community-acquired pneumonia but was associated with severe disease. S pneumoniae was detected most often. Blood culture was of low yield in general but may have greater use in those with parapneumonic effusion and ICU admission.",
author = "Fritz, {Cristin Q.} and Edwards, {Kathryn M.} and Self, {Wesley H.} and Grijalva, {Carlos G.} and Yuwei Zhu and Arnold, {Sandra R.} and McCullers, {Jonathan A.} and Krow Ampofo and Pavia, {Andrew T.} and Wunderink, {Richard G} and Anderson, {Evan J.} and Bramley, {Anna M.} and Seema Jain and Williams, {Derek J.}",
year = "2019",
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doi = "10.1542/peds.2018-3090",
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Fritz, CQ, Edwards, KM, Self, WH, Grijalva, CG, Zhu, Y, Arnold, SR, McCullers, JA, Ampofo, K, Pavia, AT, Wunderink, RG, Anderson, EJ, Bramley, AM, Jain, S & Williams, DJ 2019, 'Prevalence, risk factors, and outcomes of bacteremic pneumonia in children', Pediatrics, vol. 144, no. 1, e20183090. https://doi.org/10.1542/peds.2018-3090

Prevalence, risk factors, and outcomes of bacteremic pneumonia in children. / Fritz, Cristin Q.; Edwards, Kathryn M.; Self, Wesley H.; Grijalva, Carlos G.; Zhu, Yuwei; Arnold, Sandra R.; McCullers, Jonathan A.; Ampofo, Krow; Pavia, Andrew T.; Wunderink, Richard G; Anderson, Evan J.; Bramley, Anna M.; Jain, Seema; Williams, Derek J.

In: Pediatrics, Vol. 144, No. 1, e20183090, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prevalence, risk factors, and outcomes of bacteremic pneumonia in children

AU - Fritz, Cristin Q.

AU - Edwards, Kathryn M.

AU - Self, Wesley H.

AU - Grijalva, Carlos G.

AU - Zhu, Yuwei

AU - Arnold, Sandra R.

AU - McCullers, Jonathan A.

AU - Ampofo, Krow

AU - Pavia, Andrew T.

AU - Wunderink, Richard G

AU - Anderson, Evan J.

AU - Bramley, Anna M.

AU - Jain, Seema

AU - Williams, Derek J.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - BACKGROUND: Previous studies examining bacteremia in hospitalized children with pneumonia are limited by incomplete culture data. We sought to determine characteristics of children with bacteremic pneumonia using data from a large prospective study with systematic blood culturing. METHODS: Children <18 years hospitalized with pneumonia and enrolled in the multicenter Etiology of Pneumonia in the Community study between January 2010 and June 2012 were eligible. Bivariate comparisons were used to identify factors associated with bacteremia. Associations between bacteremia and clinical outcomes were assessed by using Cox proportional hazards regression for length of stay and logistic regression for ICU admission and invasive mechanical ventilation or shock. RESULTS: Blood cultures were obtained in 2143 (91%) of 2358 children; 46 (2.2%) had bacteremia. The most common pathogens were Streptococcus pneumoniae (n = 23, 50%), Staphylococcus aureus (n = 6, 13%), and Streptococcus pyogenes (n = 4, 9%). Characteristics associated with bacteremia included male sex, parapneumonic effusion, lack of chest indrawing or wheezing, and no previous receipt of antibiotics. Children with bacteremia had longer lengths of stay (median: 5.8 vs 2.8 days; adjusted hazard ratio: 0.79 [0.73-0.86]) and increased odds of ICU admission (43% vs 21%; adjusted odds ratio: 5.21 [3.82-6.84]) and invasive mechanical ventilation or shock (30% vs 8%; adjusted odds ratio: 5.28 [2.41-11.57]). CONCLUSIONS: Bacteremia was uncommonly detected in this large multicenter cohort of children hospitalized with community-acquired pneumonia but was associated with severe disease. S pneumoniae was detected most often. Blood culture was of low yield in general but may have greater use in those with parapneumonic effusion and ICU admission.

AB - BACKGROUND: Previous studies examining bacteremia in hospitalized children with pneumonia are limited by incomplete culture data. We sought to determine characteristics of children with bacteremic pneumonia using data from a large prospective study with systematic blood culturing. METHODS: Children <18 years hospitalized with pneumonia and enrolled in the multicenter Etiology of Pneumonia in the Community study between January 2010 and June 2012 were eligible. Bivariate comparisons were used to identify factors associated with bacteremia. Associations between bacteremia and clinical outcomes were assessed by using Cox proportional hazards regression for length of stay and logistic regression for ICU admission and invasive mechanical ventilation or shock. RESULTS: Blood cultures were obtained in 2143 (91%) of 2358 children; 46 (2.2%) had bacteremia. The most common pathogens were Streptococcus pneumoniae (n = 23, 50%), Staphylococcus aureus (n = 6, 13%), and Streptococcus pyogenes (n = 4, 9%). Characteristics associated with bacteremia included male sex, parapneumonic effusion, lack of chest indrawing or wheezing, and no previous receipt of antibiotics. Children with bacteremia had longer lengths of stay (median: 5.8 vs 2.8 days; adjusted hazard ratio: 0.79 [0.73-0.86]) and increased odds of ICU admission (43% vs 21%; adjusted odds ratio: 5.21 [3.82-6.84]) and invasive mechanical ventilation or shock (30% vs 8%; adjusted odds ratio: 5.28 [2.41-11.57]). CONCLUSIONS: Bacteremia was uncommonly detected in this large multicenter cohort of children hospitalized with community-acquired pneumonia but was associated with severe disease. S pneumoniae was detected most often. Blood culture was of low yield in general but may have greater use in those with parapneumonic effusion and ICU admission.

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DO - 10.1542/peds.2018-3090

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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 Jan 1;144(1). e20183090. https://doi.org/10.1542/peds.2018-3090