title: [Clinical predictors of bacteremia in immunocompetent adult patients hospitalized for community-acquired pneumonia].
abstract: BACKGROUND
  The clinical usefulness of blood cultures in the management of patients hospitalized with community-acquired pneumonia (CAP) is controversial.
  
  
  OBJECTIVE
  To determine clinical predictors of bacteremia in a cohort of adult patients hospitalized for community-acquired pneumonia.
  
  
  METHODS
  A prospective cohort of 605 immunocompetent adult patients aged 16 to 101 years (54% male) hospitalized for CAP was studied. The clinical and laboratory variables measured at admission were associated with the risk of bacteremia by univariate and multivariate analysis using logistic regression models.
  
  
  RESULTS
  Seventy seven percent of patients had comorbidities, median hospital stay was 9 days, 7.6% died in hospital and 10.7% at 30 days. The yield of the blood cultures was 12.6% (S. pneumoniae in 69 patients, H. influenzae in 3, Gram negative bacteria in three and S. aureus in one). These results modified the initial antimicrobial treatment in one case (0.2%). In a multivariate analysis, clinical and laboratory variables associated with increased risk of bacteremia were low diastolic blood pressure (Odds ratio (OR): 1.85, 95% confidence intervals (CI) 1.02 to 3.36, p < 0.05), leukocytosis e" 15,000/mm³ (OR: 2.18, 95% CI 1.22 to 3.88, p < 0.009), serum urea nitrogen e" 30 mg/dL (OR: 2.23, 95% CI 1.22 to 4.05, p < 0.009) and serum C-reactive protein e" 30 mg/dL (OR: 2.20, 95% CI 1.22 to 3.97, p < 0.01). Antimicrobial use before hospital admission significantly decreased the blood culture yield (OR: 0.14, 95% CI 0.04 to 0.46, p < 0.002).
  
  
  CONCLUSIONS
  Blood cultures do not contribute significantly to the initial management of patients hospitalized for community-acquired pneumonia. The main clinical predictors of bacteremia were antibiotic use, hypotension, renal dysfunction and systemic inflammation.
authors.forename: Fernando
authors.initials: F
authors.lastname: Saldías P
authors.forename: Tomás
authors.initials: T
authors.lastname: Reyes B
authors.forename: Josefina
authors.initials: J
authors.lastname: Sáez B
authors.forename: Carmen
authors.initials: C
authors.lastname: Rain M
authors.forename: Pamela
authors.initials: P
authors.lastname: Illanes C
authors.forename: Catalina
authors.initials: C
authors.lastname: Briceño V
authors.forename: Orlando
authors.initials: O
authors.lastname: Díaz P
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D002318:Cardiovascular Diseases / Q000150:complications; D017714:Community-Acquired Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007022:Hypotension / Q000150:complications; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D011018:Pneumonia, Pneumococcal / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D011379:Prognosis; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000150:complications; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents