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Streptococcus pneumoniae is the most common pathogen, and urinary antigen testing supports diagnosis, yet blood culture yields are often low and guidance differs. A 77-year-old man with pneumococcal pneumonia confirmed by urinary antigen testing had blood cultures positive for Klebsiella variicola. This co-infection would have been missed without blood cultures. The report highlights routine blood cultures in CAP diagnosis and supports Japanese Respiratory Society recommendations for hospitalised patients.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/reconsidering-the-role-of-blood-cultures-in-community-acquired-pneumonia-a-case-of-co-infection-with-streptococcus-pneumoniae-and-klebsiella-variicola/444313/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/reconsidering-the-role-of-blood-cultures-in-community-acquired-pneumonia-a-case-of-co-infection-with-streptococcus-pneumoniae-and-klebsiella-variicola/444313.png","ImageObject",300,407,{"name":92,"@type":93},"Stanley","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-03","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why are blood cultures important in community-acquired pneumonia (CAP) according to this case?","Question",{"text":112,"@type":113},"The co-infection with Klebsiella variicola was detected only through blood cultures, meaning it would have been missed otherwise. The report emphasizes routine blood cultures to improve diagnostic accuracy and management in hospitalised patients.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was pneumococcal infection confirmed in the patient?",{"text":117,"@type":113},"Pneumococcal pneumonia was confirmed by a positive urinary pneumococcal antigen test result after admission.",{"name":119,"@type":110,"acceptedAnswer":120},"What pathogens were found and how was antimicrobial therapy managed?",{"text":121,"@type":113},"Blood cultures later yielded Streptococcus pneumoniae and Klebsiella variicola. Treatment started with ceftriaxone for pneumococcal pneumonia, then switched to oral levofloxacin and completed a 14-day course per Japanese Respiratory Society guidance.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},444313,1790765304,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":52,"preview_page_count":4},2336477405376,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","Respirology Case Reports  \nCASE REPORT  OPEN ACCESS   \nReconsidering the Role of Blood Cultures in Community-Acquired Pneumonia: A Case ofCo-Infection With Streptococcus pneumoniae and Klebsiella variicola  \nNaoki Fujimoto1,2 | Issei Oi1 | Kohei Fujita1  | Saiki Yoshimura1 | Takanori Ito1 | Takuma Imakita1 | Osamu Kanai1 | Kiminobu Tanizawa1  \n1Division of Respiratory Medicine, Center for Respiratory Diseases, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto,  \nJapan | 2Department of Respiratory Medicine, Hikone Municipal Hospital, Hikone, Shiga, Japan Correspondence: Issei Oi ([ohi22220621@gmail.com](ohi22220621@gmail.com))  \nReceived: 21 November 2025 | Revised: 10 December 2025 | Accepted: 14 December 2025  \nAssociate Editor: Takahiro Takazono  \nKeywords: blood culture | co-infection | community-acquired pneumonia | Klebsiella variicola | Streptococcus pneumoniae  \nABSTRACT  \nCommunity-acquired pneumonia (CAP) remains a leading cause of morbidity and mortality. Streptococcus pneumoniae is the most common causative pathogen, with urinary antigen testing aiding the diagnosis thereof; however, blood culture yields are low, and guideline recommendations vary. We herein report a case of a 77-year-old man with pneumococcal pneumonia confirmed by urinary antigen testing whose blood cultures also revealed Klebsiella variicola. The detection of this co-infection would have been missed without blood cultures. Moreover, this combination of pathogens is first reported. This case underscores the importance of routine blood cultures in CAP diagnosis and supports the Japanese Respiratory Society's recommendation for their use in hospitalised patients.  \n1 | Introduction  \nCommunity-acquired pneumonia (CAP) is a common infectious disease, with an estimated annual incidence of approximately 1.88 million cases in Japan. The fatality rate of CAP remains approximately 2%–4%, and pneumonia accounts for the fourth leading cause of death in Japan. Streptococcus pneumoniae is the most frequently identified causative pathogen of CAP, followed by Haemophilus influenzae, Staphylococcus aureus, and Mycoplasma pneumoniae in Japan. Identifying the causative pathogen is fundamental for choosing effective antibiotic therapy. National guidelines differ regarding the recommended microbiological examinations at the time of admission for patients with CAP [1–3], and the Japanese Respiratory Society (JRS) recommends routine blood cultures for hospitalised patients [1] . Herein, we report a case of CAP caused by co-infection with S.  \npneumoniae and Klebsiella variicola, which could not have been diagnosed without blood cultures. This case emphasises the importance of performing blood cultures for accurate diagnosis and appropriate management of CAP, supporting the JRS guideline recommendations.  \n2 | Case Report  \nA 77-year-old man with well-controlled type 2 diabetes and untreated mycobacterium avium complex lung disease presented to a family clinic with progressive dyspnoea. Chest radiography revealed an infiltrative shadow in the right lung field (Figure 1), and the patient was referred to the emergency department for further investigation. Laboratory tests revealed leukopenia and marked elevation of inflammatory markers (Table 1), while  \nThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \n© 2026 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.  \nRespirology Case Reports, 2026; 14:e70457 1 of 4  \n[https://doi.org/10.1002/rcr2.70457](https://doi.org/10.1002/rcr2.70457)  \nFIGURE 1 | Chest radiography at initial examination. Chest radiography showing an infiltrative shadow in the right lung field, raising suspicion of pneumonia and prompting referral for further evaluation.  \nchest computed tomography (","cbCaib44ZxsZ9Men","https://ap.wps.com/l/cbCaib44ZxsZ9Men","pdf",441827,"English","# Introduction\n# Case Report\n# Discussion","[{\"question\":\"Why are blood cultures important in community-acquired pneumonia (CAP) according to this case?\",\"answer\":\"The co-infection with Klebsiella variicola was detected only through blood cultures, meaning it would have been missed otherwise. The report emphasizes routine blood cultures to improve diagnostic accuracy and management in hospitalised patients.\"},{\"question\":\"How was pneumococcal infection confirmed in the patient?\",\"answer\":\"Pneumococcal pneumonia was confirmed by a positive urinary pneumococcal antigen test result after admission.\"},{\"question\":\"What pathogens were found and how was antimicrobial therapy managed?\",\"answer\":\"Blood cultures later yielded Streptococcus pneumoniae and Klebsiella variicola. Treatment started with ceftriaxone for pneumococcal pneumonia, then switched to oral levofloxacin and completed a 14-day course per Japanese Respiratory Society guidance.\"}]","Reconsidering the Role of Blood Cultures in Community-Acquired Pneumonia - A Case of Co-Infection With Streptococcus pneumoniae and Klebsiella variicola | PDF",1790707517]