Are blood cultures necessary in community-acquired pneumonia?

Chambers, Daniel C. and Waterer, Grant W. (2005) Are blood cultures necessary in community-acquired pneumonia?. Clinical Pulmonary Medicine, 12 3: 146-152. doi:10.1097/01.cpm.0000163189.23997.f0


Author Chambers, Daniel C.
Waterer, Grant W.
Title Are blood cultures necessary in community-acquired pneumonia?
Journal name Clinical Pulmonary Medicine   Check publisher's open access policy
ISSN 1068-0640
1536-5956
Publication date 2005-05
Sub-type Article (original research)
DOI 10.1097/01.cpm.0000163189.23997.f0
Volume 12
Issue 3
Start page 146
End page 152
Total pages 7
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Language eng
Abstract Blood cultures are included in all current community-acquired pneumonia (CAP) management guidelines. However, recent studies have cast doubt on the utility of blood cultures to affect patient outcomes. To be an effective tool, a test needs to have sufficient sensitivity and specificity in the patient group of interest to alter physician prescribing habits, and when made, those changes need to impact positively on outcome. The yield of blood cultures varies but averages 7% to 8%, with a significant (4%-5%) false positive rate. Blood cultures are more likely to be positive in patients with comorbidities (particularly liver disease, chronic obstructive pulmonary disease, alcoholism and diabetes), in patients admitted to the intensive care unit, and in patients with more abnormal vital signs at presentation. Antibiotics prior to presentation markedly reduce the likelihood of a positive blood culture. When blood culture-guided changes in treatment are made, there is little other than anecdotal evidence that outcomes are improved, possibly due to the time period between the administration of effective antibiotics and a positive impact on outcome. Clinicians' reluctance to alter antibiotic therapy based on positive blood cultures further reduces their ability to affect outcomes. Given these limitations, blood cultures are unlikely to influence outcomes in previously well patients with less severe CAP, particularly if they have received previous antibiotic therapy. Despite these significant limitations, blood cultures are probably still advisable in patients with severe CAP due to the high mortality in this group.
Keyword Pneumonia
Bacteremia
Cultures
Significance
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: ERA 2012 Admin Only
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Created: Thu, 01 Dec 2011, 17:25:40 EST by Daniel Chambers on behalf of Medicine - Prince Charles Hospital