Limited usefulness of initial blood cultures in community acquired pneumonia
Limited usefulness of initial blood cultures in community acquired pneumonia
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DOI：
10.1136/emj.2003.005306
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发表时间：
2004-07-01
影响因子：
3.1
通讯作者：
Gallagher, EJ
中科院分区：
文献类型：
--
作者：
Corbo, J;Friedman, B;Gallagher, EJ
目的：社区获得性肺炎（CAP）的发病率每年约为400万例，住院率为20%。在因CAP住院的非免疫功能低下患者中，菌血症的发生率低于7%，病原体可预测。尽管如此，指南仍然建议使用血培养（BC）来指导治疗。本研究检验了假阳性BC比例将超过真阳性比例的主要假设。一个次要目的是量化的频率与抗生素治疗的基础上改变BC results.Method：conceptive成年人从城市急诊科（艾德）与CAP 1999年1月至2001年3月住院进行了回顾性评估研究资格。入院胸片显示浸润符合肺炎且在给予抗生素前在艾德至少采集了一组BC的患者入组研究。住院患者在过去两周内，疗养院居民，免疫抑制patientsexcluded.Results：821例患者被接纳为CAP和355符合纳入标准。假阳性BC比例（10%）超过真阳性比例（9%）1%（95% CI-3.3%至5.5%）。抗生素治疗的基础上改变了BC结果在5%的患者（95%CI 3%至8%hold.Conclusion）：假阳性率的BC在CAP住院患者的真阳性率相似。BC仅偶尔导致抗生素治疗的变化，并且在任何情况下，治疗变化都不是由耐药微生物的检测驱动的。结果质疑常规BCs在免疫功能正常的CAP患者中的效用。
Objective: The incidence of community acquired pneumonia (CAP) is about 4 million cases per year, with a hospitalisation rate of 20%. In non-immunocompromised patients hospitalised for CAP the rate of bacteraemia is less than 7% with predictable pathogens. Despite this, guidelines still recommend use of blood cultures (BCs) to direct treatment. This study tested the primary hypothesis that the proportion of false positive BCs would exceed the proportion of true positives. A secondary aim was to quantify the frequency with which antibiotic therapy was changed based on BC results.Method: Consecutive adults hospitalised from an urban emergency department (ED) with CAP between January 1999 and March 2001 were assessed retrospectively for study eligibility. Those with an infiltrate consistent with pneumonia on the admission chest radiograph and at least one set of BCs taken in the ED before antibiotics were given were entered into the study. Patients hospitalised within the previous two weeks, nursing home residents, and immunosuppressed patients were excluded.Results: 821 patients were admitted for CAP and 355 met inclusion criteria. The proportion of false positive BCs (10%) exceeded the proportion of true positives (9%), by 1% (95% CI -3.3% to 5.5%). Antibiotic therapy was changed on the basis of BC results in 5% of patients (95% CI 3% to 8%).Conclusion: The rate of false positive BCs in patients hospitalised with CAP is similar to the rate of true positives. BCs only infrequently lead to changes in antibiotic therapy, and in no instance were therapeutic changes driven by detection of resistant organisms. The results question the utility of routine BCs in immunocompetent patients with CAP.