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Blood cultures for community-acquired pneumonia: Are they worthy of two quality measures? A systematic review†
Article first published online: 13 FEB 2009
Copyright © 2009 Society of Hospital Medicine
Journal of Hospital Medicine
Volume 4, Issue 2, pages 112–123, February 2009
How to Cite
Afshar, N., Tabas, J., Afshar, K. and Silbergleit, R. (2009), Blood cultures for community-acquired pneumonia: Are they worthy of two quality measures? A systematic review. J. Hosp. Med., 4: 112–123. doi: 10.1002/jhm.382
There was no external funding source for this systematic review.
- Issue published online: 13 FEB 2009
- Article first published online: 13 FEB 2009
- Manuscript Accepted: 12 FEB 2008
- Manuscript Revised: 23 JAN 2008
- Manuscript Received: 3 JUL 2007
- blood cultures;
- quality measures
Obtaining blood cultures (BCs) for patients hospitalized with community-acquired-pneumonia (CAP) has been recommended by experts and used as a measure of quality of care. However, BCs are infrequently positive in these patients and their effect on clinical management has been questioned.
We performed a systematic review of the literature to determine the impact of BCs on clinical management in CAP requiring hospitalization and thus its appropriateness as a quality measure.
We searched MEDLINE, MEDLINE In-Process, and the Cochrane databases for English-language studies that reported the effect of BCs on management of adults hospitalized with CAP. We also searched the reference lists of included studies and background articles and asked experts to review our list for completeness.
Studies were chosen if they included adults admitted to the hospital with CAP, BCs were obtained at admission, and BC-directed management changes were reported.
We abstracted study design, BC positivity, and frequency of BC-directed management changes.
Fifteen studies, all with observational cohort design, were identified and reviewed. Two included only patients with BCs positive for pneumococcus, yielding 13 studies for the primary analysis. BCs were true-positive in 0% to 14% of cases. They led to antibiotic narrowing in 0% to 3% of patients and to antibiotic broadening ultimately associated with a resistant organism in 0% to 1% of patients.
BCs have very limited utility in immunocompetent patients hospitalized with CAP. Pneumonia quality measures that include BCs should be reassessed. Journal of Hospital Medicine 2009;4:112–123. © 2009 Society of Hospital Medicine.