Clinical utility of blood cultures in adult patients with community- acquired pneumonia without defined underlying risks

Naga Chalasani, M. A L Valdecanas, A. K. Gopal, J. E. McGowan, R. L. Jurado

Research output: Contribution to journalArticle

134 Citations (Scopus)

Abstract

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) quantified. 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.

Original languageEnglish (US)
Pages (from-to)932-936
Number of pages5
JournalChest
Volume108
Issue number4
StatePublished - 1995
Externally publishedYes

Fingerprint

Pneumonia
Anti-Bacterial Agents
Blood Culture
County Hospitals
Streptococcus pyogenes
Haemophilus influenzae
Sickle Cell Anemia
Streptococcus pneumoniae
Nursing Homes
Sputum
Cost-Benefit Analysis
Length of Stay
Hypersensitivity
Thorax
Steroids
HIV
Escherichia coli
Drug Therapy

Keywords

  • bacteremia
  • blood cultures
  • pneumonia

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Chalasani, N., Valdecanas, M. A. L., Gopal, A. K., McGowan, J. E., & Jurado, R. L. (1995). Clinical utility of blood cultures in adult patients with community- acquired pneumonia without defined underlying risks. Chest, 108(4), 932-936.

Clinical utility of blood cultures in adult patients with community- acquired pneumonia without defined underlying risks. / Chalasani, Naga; Valdecanas, M. A L; Gopal, A. K.; McGowan, J. E.; Jurado, R. L.

In: Chest, Vol. 108, No. 4, 1995, p. 932-936.

Research output: Contribution to journalArticle

Chalasani, N, Valdecanas, MAL, Gopal, AK, McGowan, JE & Jurado, RL 1995, 'Clinical utility of blood cultures in adult patients with community- acquired pneumonia without defined underlying risks', Chest, vol. 108, no. 4, pp. 932-936.
Chalasani, Naga ; Valdecanas, M. A L ; Gopal, A. K. ; McGowan, J. E. ; Jurado, R. L. / Clinical utility of blood cultures in adult patients with community- acquired pneumonia without defined underlying risks. In: Chest. 1995 ; Vol. 108, No. 4. pp. 932-936.
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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 (≥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) quantified. 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.

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