RT Journal Article
SR Electronic
T1 Predictive factors for true bacteremia and clinical utility of blood cultures as a prognostic tool in patients with community-onset pneumonia
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP PA2585
DO 10.1183/13993003.congress-2016.PA2585
VO 48
IS suppl 60
A1 Jong Hoo Lee
A1 Yee Hyung Kim
YR 2016
UL http://erj.ersjournals.com/content/48/suppl_60/PA2585.abstract
AB Background: Although blood cultures (BCs) are important diagnostic practice for antibiotic management in patients with pneumonia, several studies have questioned whether this practice should perform or not.Methods: This study was retrospectively conducted in adult patients with community-onset pneumonia. True bacteremia (TB) group, and contaminants or negative bacteremia (CNB) group were classified through bacterial growth on BC media and were investigated its clinical relevance.Results: A total of 785 patients were enrolled, the TB group and CNB group were 36 patients (4.5%) and 749 (95.4%), respectively. Only 10 patients (1.2%) altered antibiotic therapy based on BC results. The TB group had worse clinical outcomes, and showed higher in-hospital mortality rates than the CNB group (30.5% vs. 10.6%; p = 0.001). Chronic liver disease (odds ratio [OR] 2.973; 95% confidence interval [CI], 1.099-8.037; p = 0.032), CURB-65 score 4 and 5 points (OR 3.484; 95% CI, 1.304-9.307; p = 0.013) and PSI class V (OR 2.405; 95% CI, 1.007-5.743; p = 0.048) were independently associated with TB. In patients having high severity pneumonia with PSI class V and CURB-65 score 4 to 5 points, the TB group tended to show high in-hospital mortality rate than the CNB group (50.0% vs. 29.4%, p = 0.060; 60.0% vs. 42.5%, p = 0.480).Conclusions: Although the identification of TB may be regard as a prognostic factor for in-hospital mortality, BCs were positive for a true pathogen in only 4.5% of cases and the impact on antibiotic management of BCs was limited. Therefore, BCs seemed to be selectively considered in patients having high severity of community-onset pneumonia.