Metersky et al identified factors associated with bacteremia in a patient with community-acquired pneumonia. This can help to identify a patient who may benefit from more aggressive management. The authors are from the University of Connecticut, Qualidigm (Connecticut), Oklahoma Foundation for Medical Quality and Centers for Medicare and Medicaid Services in Seattle.
Patient selection: Medicare admitted to hospital with pneumonia (presumable age >= 65 years)
Outcome: bacteremia
Predictors (8)
Odds Ratio (Derivation Cohort)
prior antibiotics (antibiotic therapy in the week before admission)
0.5
liver disease
2.3
systolic blood pressure < 90 mm Hg
1.7
temperature < 35°C OR >= 40°C
1.9
pulse >= 125 beats per minute
1.9
serum BUN >= 30 mg/dL
2.0
serum sodium < 130 mmol/L
1.6
WBC count < 5,000 per µL or > 20,000 per µL
1.7
where:
• Pneumonia in an older adult with a history of antibiotic therapy should raise a question about antibiotic resistance.
cumulative odds ratio =
= PRODUCT(odds ratios for each predictor)
Hx Prior Antibiotics
Other 7 Parameters
Risk of Bacteremia
yes
0
low (2%)
no
0
moderate (5%
yes
1
moderate (4%)
no
1
high (9%)
NA
>= 2
high (14%)
The authors used the risk of bacteremia to determine whether to draw blood cultures and if so how many. They did not draw blood cultures on low risk patients.
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