Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (as per core measure PN-3b) mandates that all pneumonia patients should have initial emergency department blood cultures done prior to administration of first dose of antibiotics. Our objective is to evaluate the usefulness and cost effectiveness of blood cultures on all patients admitted with pneumonia. We also wanted to see if there was a need to change antibiotics based on blood culture results.
Retrospective chart review of all patients admitted and discharged with pneumonia over a period of 2 years (January 1 2007 to December 31 2008) was done in our institution, a teaching community hospital. Patients aged 18 and over were included in study. The data collected included demographic information, WBC count, blood culture results with culture and sensitivity patterns, place from where patients came to emergency department, level of care provided on admission and if antibiotics were changed after blood culture results. Pneumonia severity index was also calculated on the patients with positive blood cultures.
Out of 830 patients admitted with pneumonia 805 (96%) had blood cultures on admission. Twenty one patients (2.5%) had positive blood cultures. The Organisms isolated from positive blood cultures are Strep. pneumoniae 6(28%), Other Strep. species 2(8%), Staph. aureus 5(23%), Klebsiella pneumonia 3(14%), Pseudomonas 1(4%), MRSA 2(8%), acinetobacter 2(8%). Seven of 21 patients went to ICU. Only 4 patients (19% of positive blood cultures; 0.48% of all pneumoina patients) had a change in the antibiotic therapy. These 4 patients were admitted to ICU and had Pneumonia Severity Index of 5.
Blood Cultures should be limited to patients with pneumonia and severe acuity of illness.
Limiting blood cultures would reduce cost and would not result in adverse outcome in our patient population. Further studies can delineate other factors that could be used to identify subgroups who would benefit from blood cultures prior to treatment for pneumonia.
Ravi Chinthakindi, No Financial Disclosure Information; No Product/Research Disclosure Information