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(Chest. 2003;123:1142-1150.)
© 2003 American College of Chest Physicians

The Contribution of Blood Cultures to the Clinical Management of Adult Patients Admitted to the Hospital With Community-Acquired Pneumonia*

A Prospective Observational Study

Samuel G. Campbell, MBBCh; Thomas J. Marrie, MD; Rosemary Anstey, ART, BAS; Garth Dickinson, MD and Stacy Ackroyd-Stolarz, MSc; for the capitaL Study Investigators{dagger}

* From the Department of Emergency Medicine (Dr. Campbell and Ms. Ackroyd-Stolarz), Dalhousie University, Halifax, NS; Division of Medicine (Dr. Marrie), University of Alberta, Edmonton, AL; Endpoint Research Ltd (Ms. Anstey), Mississauga, ON; and Division of Emergency Medicine (Dr. Dickinson), University of Ottawa, Ottawa, ON, Canada. {dagger} A list of participants and participating centers is given in the Appendix.

Correspondence to: Samuel G. Campbell, MBBCh, Department of Emergency Medicine, Queen Elizabeth II Health Sciences Centre, 1796 Summer St, Halifax, NS, Canada B3H 3A7; e-mail: sgcampbe{at}is.dal.ca

Study objective: To assess the clinical usefulness of blood cultures (BCs) in the management of patients hospitalized with community-acquired pneumonia (CAP).

Design: A prospective, observational study to investigate the contribution of BCs to the management and outcomes of adult patients presenting with CAP. Setting: Nineteen Canadian hospitals.

Patients: Adults admitted to the hospital with CAP between January 1, 1998, and July 31, 1998. Interventions: The courses of therapy in patients for whom BC results yielded organisms considered to be clinically significant were analyzed to determine whether the BCs had contributed to management or outcome.

Measurements and results: Forty-three of 760 patients had significantly positive BC results. Patients with CAP who had BCs performed had a 1.97% chance (15 of 760 patients) of having a change of therapy directed by BC results. Patients in whom BCs yielded positive results had a 34.8% chance (15 of 43 patients) of having a change in therapy determined by BC results, and had a 58.1% chance (25 of 43 patients) of having a course of therapy contraindicated by BC results. Severity of illness, as measured by the pneumonia severity index, correlated poorly with the yield of BCs. BC results were positive in 8.0% of patients in risk classes I and II, 6.2% of patients in risk class III, 4.6% of patients in risk class IV, and 5.2% of patients in risk class V.

Conclusion: BCs have limited usefulness in the routine management of patients admitted to the hospital with uncomplicated CAP.

Key Words: blood cultures • clinical practice guidelines • community-acquired pneumonia • microbiology




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