Journal Article

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

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

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 49, issue 3, pages 409-416
Published in print August 2009 | ISSN: 1058-4838
Published online August 2009 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/600291
A Prediction Rule for Estimating the Risk of Bacteremia in Patients with Community-Acquired Pneumonia

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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.

Journal Article.  3916 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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