Selective Use of Blood Cultures in Emergency Department Pneumonia Patients

J Emerg Med. 2007 Jul;33(1):1-8. doi: 10.1016/j.jemermed.2006.12.034. Epub 2007 Jun 18.

Abstract

Our objectives were to identify factors associated with positive blood cultures and to evaluate blood culture use in the management of hospitalized pneumonia patients to limit their use. A retrospective chart review was conducted at a community teaching hospital. Emergency Department patients with an admission diagnosis of pneumonia during calendar years 2001-2002 were included. Patients younger than age 18 years and those with a non-pneumonia discharge diagnosis were excluded. Of 684 eligible patients, 23 (3.4%) had true positive blood cultures. All organisms were sensitive to empiric antibiotics. Three risk factors were associated with positive blood cultures: oxygen saturation < 90%, serum sodium < 130 and respiratory rate > 30 breaths/min. No patient had antibiotic coverage broadened based on blood culture results. Positive blood culture rates were low and did not affect the clinical management of pneumonia patients. We recommend eliminating blood cultures in community-acquired pneumonia (CAP) patients, but obtaining blood cultures in patients at risk for multi-drug resistant pathogens, such as health-care-associated pneumonia (HCAP) patients.

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Chi-Square Distribution
  • Community-Acquired Infections / blood*
  • Community-Acquired Infections / drug therapy
  • Emergency Service, Hospital
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Pneumonia, Bacterial / blood*
  • Pneumonia, Bacterial / drug therapy
  • Practice Guidelines as Topic
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index

Substances

  • Anti-Bacterial Agents