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Research Letter |

Blood Culture Use in the Emergency Department in Patients Hospitalized for Community-Acquired Pneumonia

Anil N. Makam, MD, MAS1; Andrew D. Auerbach, MD, MPH2; Michael A. Steinman, MD3
[+] Author Affiliations
1Division of General Internal Medicine, University of Texas Southwestern Medical Center, Dallas
2Divsion of Hospital Medicine, University of California, San Francisco
3Division of Geriatrics, San Francisco VA Medical Center and the University of California, San Francisco
JAMA Intern Med. 2014;174(5):803-806. doi:10.1001/jamainternmed.2013.13808.
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Routine blood cultures for all patients hospitalized with community-acquired pneumonia have limited utility, and false-positive results lead to inappropriate antimicrobial use and longer hospital stays.1 As a result, performance measures and practice guidelines that promoted obtaining blood cultures in all such patients were modified from 2005 through 2007 to recommend routine collection in only the sickest patients.1,2 Using a national sample of emergency department visits, we examined patterns of obtaining cultures in adults hospitalized with community-acquired pneumonia.

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Trends in Collecting Blood Cultures During ED Visits by Patients Subsequently Hospitalized by Condition for 2002 Through 2010

CMS indicates Centers for Medicaid & Medicare Services; ED, emergency department; JCAHO, Joint Commission on Accreditation of Healthcare Organizations; UTI, urinary tract infection. Blood culture collection data were not recorded in the 2005 and 2006 surveys. In 2002, the JCAHO and CMS announced a core measure for routine blood culture collection in the ED for all patients hospitalized with community-acquired pneumonia to benchmark the quality of care. This was subsequently revised in 2005 to focus only on intensive care unit admissions. Practice guidelines for the management of pneumonia were revised at the beginning of 2007 to recommend routine blood cultures only for patients with severe community-acquired pneumonia. aDifference in the trend lines was evaluated by testing the interaction term of year and condition in a regression model using the collection of a blood culture as the outcome variable.

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