Afshar Nima, Tabas Jeffrey, Afshar Kia, Silbergleit Robert
Department of Medicine, University of California, San Francisco, San Francisco, California 94143-0131, USA.
J Hosp Med. 2009 Feb;4(2):112-23. doi: 10.1002/jhm.382.
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.
专家推荐对社区获得性肺炎（CAP）住院患者进行血培养（BC），并将其作为医疗质量的一项衡量指标。然而，这些患者血培养结果很少呈阳性，其对临床管理的影响也受到质疑。
我们对文献进行了系统综述，以确定血培养对需要住院治疗的CAP患者临床管理的影响，从而确定其作为质量指标的合理性。
我们检索了MEDLINE、MEDLINE In-Process和Cochrane数据库，查找报告血培养对CAP住院成人患者管理影响的英文研究。我们还检索了纳入研究和背景文章的参考文献列表，并请专家审查我们的列表以确保完整性。
纳入的研究需包含因CAP入院的成人患者、入院时进行血培养且报告了基于血培养结果的管理变化。
我们提取了研究设计、血培养阳性率以及基于血培养结果的管理变化频率。
共识别并审查了15项均采用观察性队列设计的研究。其中两项研究仅纳入血培养肺炎球菌阳性的患者，因此主要分析纳入了13项研究。血培养真阳性率为0%至14%。血培养结果导致0%至3%的患者抗生素使用范围缩小，最终导致0%至1%的患者因耐药菌而扩大抗生素使用范围。
血培养对免疫功能正常的CAP住院患者作用非常有限。应重新评估包含血培养的肺炎质量指标。
