• Miquel Falguera, Javier Trujillano, Sílvia Caro, Rosario Menéndez, Jordi Carratalà, Agustín Ruiz-González, Manuel Vilà, Mercè García, José Manuel Porcel, Antoni Torres, and NAC-CALIDAD (Proyecto Integrado de Investigación de la Sociedad Española de Patología del Aparato Respiratorio sobre Infecciones Respiratorias de Vías Bajas) Study Group.
• Services of 1Internal Medicine, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Institut de Recerca Biomèdia de Lleida, Ciber de Enfermedades Respiratorias, Lleida, Spain. mfalguera@comll.cat
• Clin. Infect. Dis. 2009 Aug 1;49(3):409-16.

BackgroundWe 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.MethodsDerivation 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.ResultsThe 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.ConclusionsThis 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.

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