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Published ahead of print on November 20, 2003, doi:10.1164/rccm.200309-1248OC

Am. J. Respir. Crit. Care Med., Volume 169, Number 3, February 2004, 342-347

A more recent version of this article appeared on February 1, 2004
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Submitted on September 8, 2003
Accepted on November 7, 2003

Predicting Bacteremia in Patients with Community-Acquired Pneumonia

Mark L Metersky1*, Allen Ma2, Dale W Bratzler2, and Peter M Houck3

1 Pulmonary Division, University of Connecticut School of Medicine, Farmington, CT, USA; Qualidigm, Middletown, CT, USA, 2 Oklahoma Foundation for Medical Quality, Inc., Oklahoma City, OK, USA, 3 Centers for Medicare and Medicaid Services, Seattle, WA, USA

* To whom correspondence should be addressed. E-mail: Metersky{at}nso.uchc.edu.

It is recommended that blood cultures be performed on all patients admitted to the hospital with pneumonia. Questions regarding the cost-effectiveness of this practice have emerged. We used data on 13,043 Medicare patients hospitalized with pneumonia to determine predictors of bacteremia. Predictors included recent antibiotic treatment, liver disease and three vital sign and three laboratory abnormalities. Patients were stratified into three groups based on the likelihood of bacteremia. We then created a decision support tool which recommends performing no blood cultures on patients with low likelihood of bacteremia, one blood culture on patients with moderate likelihood of bacteremia, and two blood cultures on patients with higher likelihood of bacteremia. This tool was then applied to a validation cohort of 12,771 patients with pneumonia. Use of the decision support tool would result in 38% fewer blood cultures being performed when compared to the standard practice of performing two blood cultures for each patient and identified 88-89% of bacteremic patients. A simplified tool performed similarly overall, but was less sensitive than was the first tool among pneumonia severity index class V patients. These tools may allow clinicians to target patients with pneumonia in whom blood cultures are most likely to yield a pathogen.
Key words: Respiratory tract infections, Decision support techniques, Diagnosis




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