Selective Use of Blood Cultures in Emergency Department Pneumonia Patients

Benenson, Ronald; Kepner, Andrew M.; Pyle, Donald N.; Cavanaugh, Sean

doi:10.1016/j.jemermed.2006.12.034

Cited by 55 publications

(53 citation statements)

References 19 publications

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“…However, there is little information regarding the prevalence and clinical impact of bacteraemia in CAP patients treated outside the hospital. Previous studies reported incidences of 2.1-7%, respectively [5][6][7][8]. However, few data exist regard predictive factors and the clinical outcomes associated with positive blood cultures in this population [8].…”

Section: Bacteraemia In Outpatients With Community-acquired Pneumoniamentioning

confidence: 83%

“…In our study, the prevalence of these cases was 7% of the total bacteraemic cases collected over 10 years. In a review of the literature, we found percentages that ranged between 2.1% and 7% [5][6][7][8]13].…”

Section: Bacteraemia In Outpatients With Community-acquired Pneumoniamentioning

confidence: 91%

“…Previous studies reported incidences of 2.1-7%, respectively [5][6][7][8]. However, few data exist regard predictive factors and the clinical outcomes associated with positive blood cultures in this population [8]. The current study aimed to determine the predictive factors and the clinical outcomes of bacteraemic outpatients with CAP, and describe their clinical, epidemiological and microbiological characteristics.…”

Section: Bacteraemia In Outpatients With Community-acquired Pneumoniamentioning

confidence: 94%

“…METERSKY et al [11] found that liver disease, recent antibiotic treatment, temperature <35°C or ⩾40°C, blood urea nitrogen ⩾30 mg·dL , and white blood cell count <5000 or >20 000 per mm 3 were associated with bacteraemia. BENENSON et al [8], in a retrospective study, found that oxygen saturation <90%, serum sodium <130 mg·dL −1 and respiratory rate >30 breaths per min were factors associated with a positive blood culture in a cohort of hospitalised patients with CAP. In another retrospective study [7] of 414 cases, positive blood cultures were identified in 7% of cases but no predictors were provided.…”

Section: Bacteraemia In Outpatients With Community-acquired Pneumoniamentioning

confidence: 99%

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Bacteraemia in outpatients with community-acquired pneumonia

et al. 2015

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Section: Bacteraemia In Outpatients With Community-acquired Pneumoniamentioning

confidence: 83%

Section: Bacteraemia In Outpatients With Community-acquired Pneumoniamentioning

confidence: 91%

Section: Bacteraemia In Outpatients With Community-acquired Pneumoniamentioning

confidence: 94%

Section: Bacteraemia In Outpatients With Community-acquired Pneumoniamentioning

confidence: 99%

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Bacteraemia in outpatients with community-acquired pneumonia

et al. 2015

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“…[ [22][23][24] We basically conducted statistical analysis based on 2 groups: TB group versus CNB group.…”

Section: Study Population and Designmentioning

confidence: 99%

Predictive factors for true bacteremia and clinical utility of blood cultures as a prognostic tool in patients with community-onset pneumonia

Lee

Kim

2016

10.1 Respiratory Infections

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Although blood cultures (BCs) are an important component of diagnostic practice for antibiotic management in patients with pneumonia, several studies have questioned whether they should be performed. The objective of this study was to evaluate the predictive factors of bacteremia and the role of BCs in patients with community-onset pneumonia (community-acquired pneumonia and healthcare-associated pneumonia).This study was retrospectively conducted in patients with community-onset pneumonia who were hospitalized at Jeju National University Hospital between January 2012 and December 2014. A true bacteremia (TB) group and a contaminants or negative bacteremia (CNB) group were classified according to the bacterial growth on the BC media and were investigated for the clinical relevance of the BCs.We enrolled 785 patients; the TB group and the CNB group contained 36 patients (4.5%) and 749 (95.4%) patients, respectively. Only 10 patients (1.2%) required a change in antibiotic therapy based on the BC results (3 patients with an escalation, 7 with a de-escalation). There was no significant difference between the community-acquired pneumonia and the healthcare-associated pneumonia groups with regard to the rate of antibiotic change due to the BC results (1.1% vs 1.4%; P = 0.751). Chronic liver disease (odds ratio [OR] 2.973, 95% confidence interval [CI] 1.099-8.037), a confusion, urea, respiratory rate, blood pressure, age ≥65 (CURB-65) score of 4 to 5 points (OR 3.484, 95% CI 1.304-9.307), and Pneumonia Severity Index (PSI) class V (OR 2.405, 95% CI 1.007-5.743) were independently associated with TB. In patients with PSI class V and a CURB-65 score of 4 to 5 points, the TB group tended to show a higher inhospital mortality rate than the CNB group (50.0% vs 29.4%; P = 0.060, 60.0% vs 42.5%; P = 0.480). The areas under the curve for PSI score and CURB-65 score for predicting TB revealed an increased tendency compared with that of C-reactive protein (0.72, 95% CI 0.630-0.809; and 0.72, 95% CI 0.622-0.819 vs 0.629, 95% CI 0.522-0.735, respectively).It seemed reasonable to selectively conduct BC in patients hospitalized with severe community-onset pneumonia based upon its low overall positive rate, its effects on antimicrobial modification, and the associations of TB with the severity indices of pneumonia.Abbreviations: ARP = antibiotic-resistant pathogens, AUC = area under the curve, BC = blood culture, CAP = communityacquired pneumonia, CI = confidence interval, CNB = contaminants or negative bacteremia, CO = community onset, CRP = Creactive protein, CURB-65 = confusion, urea, respiratory rate, blood pressure, age ≥65, HCAP = healthcare-associated pneumonia, MDR = multidrug-resistant, PSI = Pneumonia Severity Index, TB = true bacteremia.

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