I'm building a "so there" file. It is meant as a go-to place to pull articles to give pesky consultants who think history can r/o ACS or that the tilt test is useful for anything other than annoying ER nurses.
Help me build my file. What papers do you have in your file?
Thanks and take care,
Jeff
Blood cultures do not change management in hospitalized patients with community-acquired pneumonia.
Ramanujam P,
Rathlev NK.
Department of Emergency Medicine, Boston University Medical Center, Boston, MA, USA.
[email protected]
OBJECTIVES: To determine if blood cultures identify organisms that are not appropriately treated with initial empiric antibiotics in hospitalized patients with community-acquired pneumonia, and to calculate the costs of blood cultures and cost savings realized by changing to narrower-spectrum antibiotics based on the results. METHODS: This was a retrospective observational study conducted in an urban academic emergency department (ED). Patients with an ED and final diagnosis of community-acquired pneumonia admitted between January 1, 2001, and August 30, 2003, were eligible when the results of at least one set of blood cultures obtained in the ED were available. Exclusion criteria included documented human immunodeficiency virus infection, immunosuppressive illness, chronic renal failure, chronic corticosteroid therapy, documented hospitalization within seven days before ED visit, transfer from another hospital, nursing home residency, and suspected aspiration pneumonia. The cost of blood cultures in all patients was calculated. The cost of the antibiotic regimens administered was compared with narrower-spectrum and less expensive alternatives based on the results. RESULTS: A total of 480 patients were eligible, and 191 were excluded. Thirteen (4.5%) of the 289 enrolled patients had true bacteremia; the organisms isolated were sensitive to the empiric antibiotics initially administered in all 13 cases (100%; 95% confidence interval = 75% to 100%). Streptococcus pneumoniae and Haemophilus influenzae were isolated in 11 and two patients, respectively. The potential savings of changing the antibiotic regimens to narrower-spectrum alternatives was only 170 dollars. CONCLUSIONS: Appropriate empiric antibiotics were administered in all bacteremic patients. Antibiotic regimens were rarely changed based on blood culture results, and the potential savings from changes were minimal.
PMID: 16766742 [PubMed - indexed for MEDLINE]
Clinical utility of blood cultures in adult patients with community-acquired pneumonia without defined underlying risks.
Chalasani NP,
Valdecanas MA,
Gopal AK,
McGowan JE Jr,
Jurado RL.
Department of Medicine, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, USA.
STUDY OBJECTIVE: We retrospectively examined the clinical utility of obtaining routine blood cultures before the administration of antibiotics in certain nonimmunosuppressed patients with community-acquired pneumonia (CAP) admitted to the hospital during 1991. DESIGN: Retrospective review. SETTING: Grady Memorial Hospital (a county hospital primarily serving inner-city Atlanta). PATIENTS OR PARTICIPANTS: Hospital discharge diagnosis listings identified 1,250 adults ( > or = 18 years old) with pneumonia. From this group of patients, we selected patients admitted to the hospital with (1) respiratory symptoms and a lobar infiltrate on chest radiograph that were present at the time of hospital admission, (2) two or more sets of blood cultures obtained within 48 h of hospital admission, and (3) absence of defined risk factors: HIV-related illness, malignancy, recent chemotherapy, steroid therapy, sickle cell disease, nursing home residence, or hospital stays within the past 14 days. MEASUREMENTS AND RESULTS: Five hundred seventeen patients (mean age, 52 years;: age range, 18 to 103 years) qualified. Of these 517 patients, 25 patients (4.8%) had growth in blood cultures considered contaminants while 34 (6.6%) had blood cultures positive for the following pathogens: 29 Streptococcus pneumoniae, 3 Haemophilus influenzae, and 1 Streptococcus pyogenes, 1 Escherichia coli. Antibiotic therapy was changed for 7 of the 34 patients with positive blood cultures (1.4% of study patients). Antibiotic regimens were altered in 48 additional patients based on sputum culture, poor clinical response, and allergic reactions. CONCLUSIONS: Few blood cultures were positive for likely infecting organisms in adult patients with CAP without defined underlying risk factors. Furthermore, a total of $34,122 was spent on blood cultures at $66 per patient. In this carefully defined group of patients, blood cultures may have limited clinical utility and questionable cost-effectiveness.
PMID: 7555163 [PubMed - indexed for MEDLINE]
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