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Blood cultures do not change management in hospitalized patients with community-acquired pneumonia.
Acad Emerg Med. 2006 Jul; 13(7):740-5.AE

Abstract

OBJECTIVES

To determine if blood cultures identify organisms that are not appropriately treated with initial empiric antibiotics in hospitalized patients with community-acquired pneumonia, and to calculate the costs of blood cultures and cost savings realized by changing to narrower-spectrum antibiotics based on the results.

METHODS

This was a retrospective observational study conducted in an urban academic emergency department (ED). Patients with an ED and final diagnosis of community-acquired pneumonia admitted between January 1, 2001, and August 30, 2003, were eligible when the results of at least one set of blood cultures obtained in the ED were available. Exclusion criteria included documented human immunodeficiency virus infection, immunosuppressive illness, chronic renal failure, chronic corticosteroid therapy, documented hospitalization within seven days before ED visit, transfer from another hospital, nursing home residency, and suspected aspiration pneumonia. The cost of blood cultures in all patients was calculated. The cost of the antibiotic regimens administered was compared with narrower-spectrum and less expensive alternatives based on the results.

RESULTS

A total of 480 patients were eligible, and 191 were excluded. Thirteen (4.5%) of the 289 enrolled patients had true bacteremia; the organisms isolated were sensitive to the empiric antibiotics initially administered in all 13 cases (100%; 95% confidence interval = 75% to 100%). Streptococcus pneumoniae and Haemophilus influenzae were isolated in 11 and two patients, respectively. The potential savings of changing the antibiotic regimens to narrower-spectrum alternatives was only 170 dollars.

CONCLUSIONS

Appropriate empiric antibiotics were administered in all bacteremic patients. Antibiotic regimens were rarely changed based on blood culture results, and the potential savings from changes were minimal.

Authors+Show Affiliations

Department of Emergency Medicine, Boston University Medical Center, Boston, MA, USA. pramanujam@ucsd.eduNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16766742

Citation

Ramanujam, Prasanthi, and Niels K. Rathlev. "Blood Cultures Do Not Change Management in Hospitalized Patients With Community-acquired Pneumonia." Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, vol. 13, no. 7, 2006, pp. 740-5.
Ramanujam P, Rathlev NK. Blood cultures do not change management in hospitalized patients with community-acquired pneumonia. Acad Emerg Med. 2006;13(7):740-5.
Ramanujam, P., & Rathlev, N. K. (2006). Blood cultures do not change management in hospitalized patients with community-acquired pneumonia. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 13(7), 740-5.
Ramanujam P, Rathlev NK. Blood Cultures Do Not Change Management in Hospitalized Patients With Community-acquired Pneumonia. Acad Emerg Med. 2006;13(7):740-5. PubMed PMID: 16766742.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Blood cultures do not change management in hospitalized patients with community-acquired pneumonia. AU - Ramanujam,Prasanthi, AU - Rathlev,Niels K, Y1 - 2006/06/09/ PY - 2006/6/13/pubmed PY - 2006/9/26/medline PY - 2006/6/13/entrez SP - 740 EP - 5 JF - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine JO - Acad Emerg Med VL - 13 IS - 7 N2 - OBJECTIVES: To determine if blood cultures identify organisms that are not appropriately treated with initial empiric antibiotics in hospitalized patients with community-acquired pneumonia, and to calculate the costs of blood cultures and cost savings realized by changing to narrower-spectrum antibiotics based on the results. METHODS: This was a retrospective observational study conducted in an urban academic emergency department (ED). Patients with an ED and final diagnosis of community-acquired pneumonia admitted between January 1, 2001, and August 30, 2003, were eligible when the results of at least one set of blood cultures obtained in the ED were available. Exclusion criteria included documented human immunodeficiency virus infection, immunosuppressive illness, chronic renal failure, chronic corticosteroid therapy, documented hospitalization within seven days before ED visit, transfer from another hospital, nursing home residency, and suspected aspiration pneumonia. The cost of blood cultures in all patients was calculated. The cost of the antibiotic regimens administered was compared with narrower-spectrum and less expensive alternatives based on the results. RESULTS: A total of 480 patients were eligible, and 191 were excluded. Thirteen (4.5%) of the 289 enrolled patients had true bacteremia; the organisms isolated were sensitive to the empiric antibiotics initially administered in all 13 cases (100%; 95% confidence interval = 75% to 100%). Streptococcus pneumoniae and Haemophilus influenzae were isolated in 11 and two patients, respectively. The potential savings of changing the antibiotic regimens to narrower-spectrum alternatives was only 170 dollars. CONCLUSIONS: Appropriate empiric antibiotics were administered in all bacteremic patients. Antibiotic regimens were rarely changed based on blood culture results, and the potential savings from changes were minimal. SN - 1553-2712 UR - https://www.unboundmedicine.com/medline/citation/16766742/Blood_cultures_do_not_change_management_in_hospitalized_patients_with_community_acquired_pneumonia_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1069-6563&date=2006&volume=13&issue=7&spage=740 DB - PRIME DP - Unbound Medicine ER -