Background and objectivesCurrent guidelines for the management of community-acquired pneumonia (CAP) in children recommend obtaining a blood culture for children with moderate to severe pneumonia; yet, there is no guidance to assess the severity of the disease. Thus, a blood culture is obtained for the majority of children admitted with CAP, regardless of the severity of their symptoms. The study was designed to investigate and identify the prevalence of bacteremia in pediatric patients hospitalized with CAP and to evaluate the clinical and laboratory variables associated with bacteremia. MethodsWe conducted a medical record review of children aged from two months to 18 years diagnosed with CAP between January 1, 2013, and December 31, 2017, at our two urban tertiary centers. We used binary logistic regression analysis and chi-square tests to look at factors associated with blood culture positivity. ResultsA total of 464 patients were admitted with CAP. Blood cultures were obtained in 357 (76.9%) patients; 23 patients had repeated cultures. Fifteen patients had positive cultures: 5/380 (1.3%) were considered true positive results and 10/380 (2.6%) were considered contaminants. Intensive care unit (ICU) admission (OR 5.6 with 95% CI (1-31), p<0.03), toxic appearance (OR 12.8 with 95% CI (1.3-125), p<0.01), and significantly elevated C-reactive protein (CRP) (>300 mg/L (p<0.01) were associated with bacteremia. ConclusionThe prevalence of bacteremia among children admitted for CAP is low. The use of routine blood cultures should be reserved for children with moderate to severe pneumonia. Further studies are required to better risk-stratify children with CAP.

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Context: several studies show that missing doses and an incorrect inhalation technique, are the most common pharmacological risks in patients with Chronic Obstructive Pulmonary Disease diagnosis. These are associated with an increase in Health-related costs, mainly due to an increase in the number of emergency visits, hospitalizations and switches of medication as a consequence of therapeutic failures.Objective: to determinate the median cost per month of each patient stratified by type of pharmacological risks, after pharmacotherapeutic follow-up assessment.Method: Follow-up cohort, in Chronic Obstructive Pulmonary Disease patients. The observation period was from January 2012 to June 2014 [n:108]. The pharmacological risks assessed were incorrect inhalation technique and missing doses. The main outcome was the median cost per month in each patient before and after having received Health-related education by a Pharmacist, stratified by having or not pharmacological risks [1 USD=1.906,9COP information to august 2014]. Wilcoxon test for paired sample and U de Mann-Whitney test for independent sample were used for this purpose. Results:The median cost per month was 165, 3[104,0-277,8], a patient without pharmacological risks was 119,2 [88,4] USD and a patient with pharmacological risks was 186,7 [123,7-307,9] [p= 0,033]. On the other hand, a patient with missing doses was 195,1 [131,6], in comparison with a patient with incorrect inhalation technique, that was 143,0 [96,0]. The cost before the Pharmacotherapeutic Follow-up implementation was 169,8 [110,8-253,8] and after that it was 150,7 [106,1], with an important decrease of 11,25% [p= 0,517]. Conclusion:Having pharmacological risks was related with a higher median cost per patient. The median cost per patient was lower after giving Health-related education to patients by Pharmacotherapeutic Follow-up.