Predicting bacteremia in patients with community-acquired pneumonia
Predicting bacteremia in patients with community-acquired pneumonia
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DOI：
10.1164/rccm.200309-1248oc
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发表时间：
2004-02-01
影响因子：
24.7
通讯作者：
Houck, PM
中科院分区：
文献类型：
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作者：
Metersky, ML;Ma, A;Houck, PM
建议对所有入院的肺炎患者进行血培养。关于这种做法的成本效益的问题已经出现。我们使用 13,043 名因肺炎住院的医疗保险患者的数据来确定菌血症的预测因素。预测因素包括最近的抗生素治疗、肝脏疾病以及三项生命体征和三项实验室异常。根据菌血症的可能性将患者分为三组。然后，我们创建了一个决策支持工具，建议对菌血症可能性较低的患者不进行血培养，对菌血症可能性中等的患者进行一次血培养，对菌血症可能性较高的患者进行两次血培养。然后将该工具应用于 12,771 名肺炎患者的验证队列。与为每位患者进行两次血培养的标准做法相比，使用决策支持工具将减少 38% 的血培养次数，并识别出 88% 至 89% 的菌血症患者。简化的工具总体表现相似，但在肺炎严重程度指数 V 级患者中的敏感性低于第一个工具。这些工具可以让临床医生瞄准血液培养最有可能产生病原体的肺炎患者。
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 on the basis of the likelihood of bacteremia. We then created a decision support tool that 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 with the standard practice of performing two blood cultures for each patient and identified 88 to 89% of patients with bacteremia. 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.