Can we predict which patients with community-acquired pneumonia are likely to have positive blood cultures？

作     者：Samuel George Campbell R. Andrew McIvor Vincent Joanis David Graydon Urquhar 

作者机构：Department of Emergency Medicine Charles V Keating Emergency and Trauma Centre 1796 Summer St Halifax NovaScotia B3H3A7 Canada (Campbell SG Urquhart DG) T2127 Firestone Institute for Respiratory Health St. Joseph′sHealth Care Hamilton Hamilton ON. L8N 4A6 Canada (McIvor RA) Foothills Medical Centre 1403 - 29th Street N.W.University of Calgary Calgary Alberta Canada (Joanis V) 

出 版 物：《World Journal of Emergency Medicine》 (世界急诊医学杂志（英文）)

年 卷 期：2011年第2卷第4期

页      面：272-278页

学科分类：100214[医学-肿瘤学] 

基　　金：Legacy Research Fund of the Lung Association of Nova Scotia 

主　　题：Community-acquired pneumonia Blood cultures 

摘      要：BACKGROUND： Blood cultures （BC ） are commonly ordered during the initial assessment ofpatients with community-acquired pneumonia （CAP）, yet their yield remains low. Selective use of BCwould allow the opportunity to save healthcare resources and avoid patient discomfort. The studywas to determine what demographic and clinical factors predict a greater likelihood of a positiveblood culture result in patients diagnosed with ***： A structured retrospective systematic chart audit was performed to comparerelevant demographic and clinical details of patients admitted with CAP, in whom blood culture resultswere positive, with those of age, sex, and date-matched control patients in whom blood cultureresults were ***： On univariate analysis, eight variables were associated with a positive BC *** logistic regression analysis, however, the only variables statistically significantly associatedwith a positive BC were WBC less than 4.5 x 109/L [likelihood ratio （LR）： 7.75, 95% CI=2.89-30.39], creatinine 〉106 !mol/L （LR： 3.15, 95%CI=1.71-5.80）, serum glucose〈6.1 mmol/L （LR： 2.46,95%CI=1.14-5.32）, and temperature 〉 38 °C （LR： 2.25, 95% CI =1.21-4.20）. A patient with all of thesevariables had a LR of having a positive BC of 135.53 （95% CI=25.28-726.8） compared to patientswith none of these ***： Certain clinical variables in patients with CAP admitted to hospitals doappear to be associated with a higher probability of a positive yield of BC, with combinations of thesevariables increasing this likelihood. We have identified a subgroup of CAP patients in whom bloodcultures are more likely to be useful.