485 - Blood Culture Utilization for Children with High Intensity Neurological Impairment Hospitalized for Pneumonia

Publication Number: 1465.485

Margaret Rush, Children's National Health System, Washington, DC, United States; Kristen Johnson, George Washington University School of Medicine and Health Sciences, Fairfax, VA, United States; Ligia Moschen Nascente Chanock, Children’s National Hospital, Washington, DC, United States; Amy Law, Children's National Health System, Washington, DC, United States; Gina Gallizzi, Children's National Health System, Washington, DC, United States; Lauretta A. Oseni, Children's National Health System, Silver Spring, MD, United States; Sajithya Perera, Children's National Health System, Washington, DC, United States; Miriam Bloom, Children's National Health System, Washington, DC, United States; Bridget Allard, Children's National Health System, Washington, DC, United States; Anand Gourishankar, Children's National Health System, Washington, DC, United States; Susan Walley, Children's National Hospital, Bethesda, MD, United States; Kavita Parikh, Children's National Health System, Washington DC, DC, United States; Gabrina Dixon, Children's National Health System, Washington, DC, United States

Background: Pneumonia is a common reason for hospitalization in children with high intensity neurological impairment (HINI). Routine blood cultures in children hospitalized with pneumonia may be unnecessary, but the practice has not been studied.

Objective: To determine if children with HINI hospitalized with pneumonia had blood cultures obtained more often than those without and describe their culture results.

Design/Methods: This was a retrospective, cross-sectional study at a single tertiary care children's hospital. We included children aged 3 months to 18 years hospitalized from January 1, 2020 to January 1, 2025 for pneumonia and identified those with HINI based on ICD-10 codes. We excluded patients who had central lines, tracheostomies, immunodeficiency, or who received vasopressors on the first day of admission. Blood culture utilization within the first 48 hours of hospitalization for children with HINI was compared to those without. Bivariate analysis and multivariable logistic regression assessed associations between blood culture utilization and clinical and demographic covariates including dysphagia, ICU admission, respiratory support and child opportunity index (COI). Hospital length of stay (LOS) and geographic risk factors were analyzed.

Results: We identified 1289 encounters for pneumonia: 280 for children with HINI and 1009 for children without. Children with and without HINI had similar illness severity as evidenced by no difference in frequency of ICU admission and respiratory support (Table 1). Twenty-two percent of children with HINI had a blood culture within the first 48 hours of hospitalization compared to 17% of those without (RR 1.30, 95% CI: 1.02-1.66). Two out of 62 cultures (3%) from the HINI group were positive, and both grew coagulase negative staphylococcus. Controlling for covariates, blood culture use was not associated with HINI but rather was associated with a dysphagia diagnosis (aOR 1.96, 95% CI 1.27-3.03), and older age (aOR 1.66, 95% CI 1.24-2.22). Children with HINI who had blood cultures had longer LOS (median (IQR): 3.9 days (2.9-7.4), 3.2 days (2.1-6.9 ), p = 0.04) Table 2). There was no disparity among groups based on zip codes or COI.

Conclusion(s): Children with HINI hospitalized for pneumonia were more likely to undergo blood culture despite similar illness severity compared to peers without HINI, which may be related to increased prevalence of dysphagia in this group. Positive culture results were rare and non-pathogenic, suggesting limited clinical utility. This highlights an opportunity to reduce unnecessary testing.

Description of the cohort and comparison across children with an HINI diagnosis and those without
Statistical differences noted in that children with HINI admitted to the hospital with pneumonia were older, more often Caucasian, were more likely to have a CRP obtained within the first 48 hours of hospitalization, had a more frequent diagnosis of dysphagia and had longer LOS. Statistics calculated using Chi square testing, Fisher exact testing and Wilcoxon Rank Sum testing for continuous variables.

Differences in demographic, social and clinical factors between children with HINI admitted with pneumonia who did or did not have a blood culture obtained within 48 hours of admission.
Older children, children requiring respiratory support and who also had CRPs were more likely to have a blood culture obtained. Children with a blood culture also had a longer hospital LOS.