title: When practice and policy conflict: blood cultures in community-acquired pneumonia.
abstract: Optimal evidence-based management of patients with uncomplicated community-acquired pneumonia in the emergency department (ED) setting remains a topic of discussion. This discussion was recently revitalized by a 2014 study published in JAMA Internal Medicine by Makam et al showing an increase in the use of blood cultures for patients with community-acquired pneumonia during ED visits from 29.4% of patients in 2002 to 51.1% in 2010. As the authors acknowledge, one of the most likely explanations could be the former pneumonia core measures required by the Centers for Medicaid & Medicare Services and the Joint Commission, potentially encouraging both ED and inpatient providers to reflexively order cultures. As these measures were the subject of fierce debate in the emergency medicine literature almost a decade ago, with recent policy changes affecting practicing clinicians, we aimed to briefly revisit the developments and concerning guidelines and discuss some important potentials for research in this setting.
authors.affiliation: Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: himali.weerahandi@mountsinai.org.
authors.forename: Himali
authors.initials: H
authors.lastname: Weerahandi
authors.affiliation: Institute for Healthcare Delivery Science, Department of Population Health Science & Policy and Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: jashvant.poeran@mountsinai.org.
authors.forename: Jashvant
authors.initials: J
authors.lastname: Poeran
authors.affiliation: Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: denise.nassisi@mountsinai.org.
authors.forename: Denise
authors.initials: D
authors.lastname: Nassisi
authors.affiliation: Institute for Healthcare Delivery Science, Department of Population Health Science & Policy and Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: madhu.mazumdar@mountsinai.org.
authors.forename: Madhu
authors.initials: M
authors.lastname: Mazumdar
mesh_terms: D017714:Community-Acquired Infections / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D004636:Emergency Service, Hospital; D006291:Health Policy; D006801:Humans; D008828:Microbiological Techniques; D011014:Pneumonia / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D018805:Sepsis / Q000175:diagnosis* / Q000382:microbiology*; D014481:United States