[Analysis of blood cultures in patients presenting with community-acquired pneumonia at the emergency room].
We retrospectively analyzed the clinical and laboratory features of 111 patients with community-acquired pneumonia (CAP) who required hospitalization. Blood culture was positive in 22, and negative in 89 subjects. We compared positive and negative groups in terms of background, physical exam findings, laboratory data, radiographic data, severity, and clinical outcome. Univariate analysis showed significant differences in heart rate, changes in consciousness, (PaO2/FiO2), C-reactive protein (CRP), and infiltration on chest x-ray films. The clinical outcome was poorer in the positive group. Multivariate analysis identified CRP and infiltration as predictors of bacteremia. According to the receiver operating characteristic (ROC) curve, CRP had moderate accuracy (AUC = 0.83 [95% confidence interval (CI) 0.60-0.88]), and diagnostic accuracy was optimal when the CRP cut-off point was 16.3 mg/dl. Fifty-seven patients, who showed mild to moderate severity according to A-DROP system and had CRP levels less than 16.3 mg/dl, were less likely to have positive blood cultures. In addition, initial administration of antibiotics was effective in each of the 57 bacteremic patients. Therefore, blood culture need not be performed in such cases.
Department of Pulmonary Medicine, Kobe City Medical Center General Hospital.
Kazuma
K
Nagata
Tetsuya
T
Hirota
Hiroshi
H
Fujiwara
D000368:Aged; D016470:Bacteremia / Q000382:microbiology; D001769:Blood / Q000382:microbiology; D017714:Community-Acquired Infections / Q000382:microbiology*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D018410:Pneumonia, Bacterial / Q000382:microbiology*; D012189:Retrospective Studies