PURPOSE: The American Thoracic Society and the American Society for Infectious Diseases recommend 2 sets of blood cultures as part of the evaluation for hospitalized pneumonia patients especially ventilator associated pneumonia and in community acquired pneumonia with pneumonia severity index(PSI)IV,V.There is however no clear data on the yield of blood cultures among nursing home patients. The purpose of our study was to assess the yield of blood cultures amongst nursing home patients admitted with pneumonia to acute care hospitals.
METHODS: This is a retrospective observational survey. Patient’s data was obtained from medical record review, March 2006 to December 2007.6 hospitals affiliated to University of Pittsburgh were included. A total of 498 patients were reviewed. Only 204 patients were included in the study. Inclusion criteria was nursing home patients with a diagnosis of pneumonia , presence of a new infiltrate on chest X ray and 2 sets of blood cultures being drawn in the first 48 hours of admission. Exclusion criteria included patients suspected with other sources of sepsis in addition to pneumonia and patients on mechanical ventilator.Pneumonia severity index was also calculated.Descriptive statistics was used to analyse the data.
RESULTS: Among the 204 patients, 100(49.01%) were males and 104(50.98%) were females.The mean age was 78.06 years(range 60-99). All the patients had a PSI ≥ III.49(24%) patients had a PSI of III,103(50.4%) had a PSI of IV and 52(25.5%) had a PSI of V.12 of 204(5.88%) patients had 2 sets of positive blood cultures. 2(16%) were positive among patients with PSI III,5(41.6%) in PSI IV and 5(41.6%) in PSI V. Out of the 12 positive cultures 8 were positive for Staphylococcus aureus, 2 for Klebsiella pneumoniae, 1 for Streptococcus pneumoniae and 1 for Escherichia coli.
CONCLUSIONS: There is a very low yield of blood cultures among nursing home patients admitted to acute care hospital with pneumonia.
CLINICAL IMPLICATIONS: Blood cultures alone may not be useful in the routine management of nursing home patients admitted with pneumonia. They might further increase the cost benefit ratio.
DISCLOSURE: The following authors have nothing to disclose: Aditya Uppalapati, Vasudev Hejamadi
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