Chest
Volume 108, Issue 4, October 1995, Pages 932-936
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Clinical Investigations: Infection: Articles
Clinical Utility of Blood Cultures in Adult Patients with Community-Acquired Pneumonia Without Defined Underlying Risks

https://doi.org/10.1378/chest.108.4.932Get rights and content

Study objective

We retrospectively examined the clinical utility of obtaining routine blood cultures before the administration of antibiotics in certain nonimmunosuppressed patients with community-acquired pneumonia (CAP) admitted to the hospital during 1991.

Design

Retrospective review.

Setting

Grady Memorial Hospital (a county hospital primarily serving inner-city Atlanta).

Patients or participants

Hospital discharge diagnosis listings identified 1,250 adults (≥18 years old) with pneumonia. From this group of patients, we selected patients admitted to the hospital with (1) respiratory symptoms and a lobar infiltrate on chest radiograph that were present at the time of hospital admission, (2) two or more sets of blood cultures obtained within 48 h of hospital admission, and (3) absence of defined risk factors: HIV-related illness, malignancy, recent chemotherapy, steroid therapy, sickle cell disease, nursing home residence, or hospital stays within the past 14 days.

Measurements and results

Five hundred seventeen patients (mean age, 52 years; age range, 18 to 103 years) qualified. Of these 517 patients, 25 patients (4.8%) had growth in blood cultures considered contaminants while 34 (6.6%) had blood cultures positive for the following pathogens: 29 Streptococcus pneumoniae., 3 Haemophilus influenzae, and 1 Streptococcus pyogenes, 1 Escherichia coli. Antibiotic therapy was changed for 7 of the 34 patients with positive blood cultures (1.4% of study patients). Antibiotic regimens were altered in 48 additional patients based on sputum culture, poor clinical response, and allergic reactions. Conclusions: Few blood cultures were positive for likely infecting organisms in adult patients with CAP without defined underlying risk factors. Furthermore, a total of $34,122 was spent on blood cultures at $66 per patient. In this carefully defined group of patients, blood cultures may have limited clinical utility and questionable cost-effectiveness.

Section snippets

Patient Population

Study patients were identified from a listing of 1,250 adults (≥18 years old) with hospital discharge diagnosis of pneumonia during 1991 at Grady Memorial Hospital, a large inner-city hospital in Atlanta. Patients with HIV infection, hematologic malignancies, metastatic solid neoplasm receiving chemotherapy, sickle cell disease, or steroid therapy were excluded. Patients were also excluded if they resided in nursing homes or had been discharged from a hospital less than 14 days prior to

Results

Of the 1,250 patients with hospital discharge diagnosis of pneumonia, 517 patients met study criteria. Ages of study patients ranged from 18 to 103 years with mode of 33 years (18 of the study patients) and mean of 51.7 years (SD±18.9). The mean age of the culture-positive patients was 43.2 years, while the mean age of the culture-negative patients was 51.8 years (p=0.007). Duration of hospital stay ranged from 0 to 31 days. Mean stay of patients with true positive cultures was 6.9 days while

Discussion

In our retrospective study of patients admitted to the hospital for CAP, blood cultures were infrequently positive in adult patients without the defined underlying risk factors. The patients we studied were directly admitted to the hospital on presentation for CAP. Of these patients, we excluded those with immunocompromised states such as HIV, hematologic and solid malignancies, sickle cell disease, steroid dependence, or nursing home residence. Fine et al20 found an increased risk of a

ACKNOWLEDGMENTS

The authors thank the developers of the Grady THERESA system for use of the database, Steve Brown, MD, for accessing the population set, Erika Elvander, MPH, for statistical assistance, and Eric Honig, MD, and David Stephens, MD, for reviewing the article before publication.

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