Journal Article

A Prediction Rule for Estimating the Risk of Bacteremia in Patients with Community-Acquired Pneumonia

Carratalà, Jordi, Menéndez, Rosario, García, Mercè, Ruiz-González, Agustín, Falguera, Miquel, Caro, Sílvia, Torres, Antoni, Trujillano, Javier, Vilà, Manuel, Porcel, José Manuel

2009

Overview

Background. We endeavored to construct a simple score based entirely on epidemiological and clinical variables that would stratify patients who require hospital admission because of community-acquired pneumonia into groups with a low or high risk of developing bacteremia. Methods. Derivation and internal validation cohorts were obtained by retrospective analysis of a database that included 3116 consecutive patients with community-acquired pneumonia from 2 university hospitals. Potential predictive factors were determined by means of a multivariate logistic regression equation applied to a cohort consisting of 60% of the patients. Points were assigned to significant parameters to generate the score. It was then internally validated with the remaining 40% of patients and was externally validated using an independent multicenter cohort of 1369 patients. Results. The overall rates of bacteremia were 12%-16% in the cohorts. The clinical probability estimate of developing bacteremia was based on 6 variables: liver disease, pleuritic pain, tachycardia, tachypnea, systolic hypotension, and absence of prior antibiotic treatment. For the score, 1 point was assigned to each predictive factor. In the derivation cohort, a cutoff score of 2 best identified the risk of bacteremia. In the validation cohorts, rates of bacteremia were <8% for patients with a score ⩽1 (43%-49% of patients), whereas blood culture results were positive in 14%-63% of cases for patients with a score ⩾2. Conclusions. This clinical score, based on readily available and objective variables, provides a useful tool to predict bacteremia. The score has been internally and externally validated and may be useful to guide diagnostic decisions for community-acquired pneumonia.

• Publisher: The University of Chicago Press,University of Chicago Press,Oxford University Press
• Subject: Aged / Antibiotics / Articles and Commentaries / Bacteremia / Bacteremia - epidemiology / Bacteria / Bacterial diseases / Bacterial pneumonia / Bacterial sepsis / Biological and medical sciences / Blood / Clinical medicine / Community-Acquired Infections - complications / Community-Acquired Infections - epidemiology / Epidemiology / Female / Health risk assessment / Human bacterial diseases / Humans / Infectious diseases / Liver diseases / Male / Medical sciences / Middle Aged / Pain / Pathogens / Pathology / Pneumology / Pneumonia / Pneumonia, Bacterial - complications / Predictive Value of Tests / Predisposing factors / Prognosis / Respiratory system : syndromes and miscellaneous diseases / Risk Assessment - methods / Risk Factors / Teaching hospitals