Document 0517
 DOCN  M9610517
 TI    Clinical utility of blood cultures in adult patients with
       community-acquired pneumonia without defined underlying risks [see
       comments]
 DT    9601
 AU    Chalasani NP; Valdecanas MA; Gopal AK; McGowan JE Jr; Jurado RL;
       Department of Medicine, Emory University School of Medicine,; Grady
       Memorial Hospital, Atlanta, USA.
 SO    Chest. 1995 Oct;108(4):932-6. Unique Identifier : AIDSLINE MED/96010146
 CM    Comment in: Chest 1995 Oct;108(4):891-2
 AB    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 ( > or = 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.
 DE    Adolescence  Adult  Aged  Aged, 80 and over  Bacteremia/*MICROBIOLOGY
       Bacteria/ISOLATION & PURIF  Community-Acquired Infections/MICROBIOLOGY
       Comparative Study  Female  Georgia  Hospitals, Public  Human  Male
       Middle Age  Pneumonia, Bacterial/*MICROBIOLOGY  Retrospective Studies
       Risk Factors  JOURNAL ARTICLE

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