Blood Culture in Evaluation of Pediatric Community-Acquired Pneumonia: A Systematic Review and Meta-analysis.
Blood Culture in Evaluation of Pediatric Community-Acquired Pneumonia: A Systematic Review and Meta-analysis.
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DOI：
10.1542/hpeds.2014-0138
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发表时间：
2015-06-01
影响因子：
--
通讯作者：
Ferrieri, Patricia
中科院分区：
文献类型：
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作者：
Iroh Tam, Pui-Ying;Bernstein, Ethan;Ferrieri, Patricia
背景和目的：目前的指南强烈建议对假定为中到重度细菌性社区获得性肺炎(CAP)而需要住院的儿童采集血培养(BCS)。我们的目标是系统地回顾国际儿科文献，以评估住院的CAP儿童BCS阳性的频率，确定最常见的分离病原体，并确定BCS阳性对临床处理的影响。方法：我们在PubMed和Scope上找到了1970年1月至2013年12月发表的关于CAP儿童BCS的文章。结果：Meta分析显示BCS总阳性率为5.14%(95%可信区间为3.61~7.28)。关注重症CAP的研究对患病率有显著影响(P=0.008)，为9.89%(95%可信区间6.79-14.19)，而不关注重症CAP的研究为4.17%(95%可信区间2.79-6.18)。最常见的致病菌是肺炎链球菌(76.7%)，其次是流感嗜血杆菌(3.1%)和金黄色葡萄球菌(2.1%)。污染物占14.7%。只有3项研究报道了BC驱动的管理变化，结果截然不同。结论：儿科CAP中的BCS只在一小部分患者中发现了微生物，主要是肺炎链球菌。假阳性BC率可能很高。这3项研究考察了BC驱动的管理层变革，结果相互矛盾。这项系统性审查受到不同病例定义的限制，这可能高估了住院儿童BCS阳性的真实流行率。
BACKGROUND AND OBJECTIVE: Current guidelines strongly recommend collection of blood cultures (BCs) in children requiring hospitalization for presumed moderate to severe bacterial community-acquired pneumonia (CAP). Our objective was to systematically review the international pediatric literature to evaluate how often BCs are positive in hospitalized children with CAP, identify the most commonly isolated pathogens, and determine the impact of positive BCs on clinical management.METHODS: We identified articles in PubMed and Scopus published from January 1970 through December 2013 that addressed BCs in children with CAP. We extracted total number of BCs collected and prevalence of positive BCs and used meta-regression to evaluate whether subgroups had any impact on prevalence.RESULTS: Meta-analysis showed that the overall prevalence of positive BCs was 5.14% (95% confidence interval 3.61-7.28). Studies focusing on severe CAP had a significant effect on prevalence (P=.008), at 9.89% (95% CI 6.79-14.19) compared with 4.17% (95% confidence interval 2.79-6.18) for studies not focusing on severe CAP. The most commonly isolated organisms were Streptococcus pneumoniae (76.7%) followed by Haemophilus influenzae (3.1%) and Staphylococcus aureus (2.1%). Contaminants accounted for 14.7%. Only 3 studies reported on BC-driven change in management, with contrasting findings.CONCLUSIONS: BCs in pediatric CAP identified organisms in only a small percentage of patients, predominantly S. pneumoniae. False-positive BC rates can be substantial. The 3 studies that examined BC-driven changes in management had conflicting results. This systematic review was limited by heterogeneous case definitions, which may overestimate the true prevalence of positive BCs in hospitalized children.