Bacteremia in Febrile Patients

Leibovici, Leonard

doi:10.1001/archinte.1991.00400090089016

Cited by 88 publications

(4 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A history of shaking chills was highly associated with bacteremia (Coburn et al 2012; Van Dissel et al 1998; Bates et al 1990; Stryjewski et al 2009; Leibovici et al 1991; Van Dissel et al 2005), and it was also confirmed among patients aged 65 years and older (Fontanarosa et al 1992). …”

Section: Discussionmentioning

confidence: 96%

Shaking chills and high body temperature predict bacteremia especially among elderly patients

et al. 2013

View full text Add to dashboard Cite

PurposesThe difference in predictors of bacteremia between elderly and non-elderly patients is unclear despite the aging of society. The objective was to determine predictors of bacteremia among elderly patients aged 80 years and older compared to non-elderly patients aged 18 to 79 years.MethodsA referral hospital-based retrospective descriptive study from April 2012 to March 2013 in Okinawa, Japan. All enrolled patients were adults suspected of having bacterial infection who had been newly admitted into the Division of Infectious Diseases. HIV- infected patients were excluded. Exposures were a history of shaking chills, prior antibiotics use within 48 hours, vital signs, and laboratory inflammation markers on admission. Outcome was blood culture positivity.ResultsThree hundred and sixty-six patients were enrolled. Median age was 78.5 (interquartile range [IQR]: 62–88). Among patients aged 18 to 79 years, shaking chills (adjusted odds ratio [AOR] 2.22, 95% confidence interval [CI]: 1.09–4.51) and previous antibiotics use (AOR 0.08, 95% CI: 0.01–0.68) were significant. However, among patients aged 80 years and older, shaking chills (AOR 3.06, 95% CI: 1.30–7.19) and body temperature above 38.5°C (AOR 2.98, 95% CI: 1.30–6.83) were significant.ConclusionsA history of shaking chills and vital signs indicating high body temperature were two findings that were useful in predicting bacteremia, especially in elderly patients aged 80 years and older. Further study is needed to assess whether the result is applicable in other regions and populations.

show abstract

Section: Discussionmentioning

confidence: 96%

Shaking chills and high body temperature predict bacteremia especially among elderly patients

et al. 2013

View full text Add to dashboard Cite

show abstract

“…This could result in the absence of adequate treatment for some infected patients and prescription of unnecessary drugs for those who are not infected [18]. The attempts to predict bacteremia using simple clinical or chemical parameters [3–6] were often of little benefit. The association of fever, low systolic blood pressure and low platelet count had only 5% sensitivity in detection of bacteremia [3].…”

Section: Discussionmentioning

confidence: 99%

“…The association of fever, low systolic blood pressure and low platelet count had only 5% sensitivity in detection of bacteremia [3]. Five parameters (serum albumin, chills, functional status, renal failure and clinical suspicion of urinary tract infection) included in a logistic model were significantly and independently correlated with bacteremia but these data allowed separation of the patients only into groups with ‘low’, ‘medium’ and ‘high’ prevalence of bacteremia [4]. CRP is one of the acute phase proteins with a shorter half‐life, and is characterized by its rapid increase during inflammation or infection [19].…”

Section: Discussionmentioning

confidence: 99%

“…However, as this diagnosis depends on positive blood cultures, the administration of appropriate antimicrobial therapy is often delayed until these results are available. Several authors have tried to predict bacteremia using immediately available parameters such as clinical signs and simple laboratory results, but the accuracy of such a diagnostic approach is poor [3–6]. Because tumor necrosis factor‐α (TNF‐α) and interleukin‐6 (IL‐6) plasma levels rapidly increase in the presence of sepsis, we sought to determine the sensitivity, specificity and predictive value of the plasma levels of these cytokines in the early detection of bacteremia in patients with suspicion of infection and compared these with clinical assessment and C‐reactive protein (CRP) plasma levels.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of tumor necrosis factor-α, interleukin-6 and C-reactive protein plasma levels as predictors of bacteremia in patients presenting signs of sepsis without shock

Byl¹,

Devière²,

Saint-Hubert³

et al. 1997

Clinical Microbiology and Infection

View full text Add to dashboard Cite

OBJECTIVE: To evaluate the sensitivity of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) plasma measurement to detect bacteremia in patients presenting sepsis signs, and to evaluate the potential benefit of such measurement in terms of early antimicrobial therapy initiation. METHODS: Plasma was obtained from 166 hospitalized patients for whom blood cultures were drawn for sepsis. Clinical data and antimicrobial therapies were noted. IL-6, TNF and C-reactive protein (CRP) were measured. The sensitivities of these markers were retrospectively compared with the accuracy of the attending physician in initiating empirical antimicrobial therapy. The setting was an 850-bed university hospital. RESULTS: Thirty-four bacteremias and 69 non-bacteremic infections were noted. In 63 others, no infection was documented. Median (range) IL-6 plasma levels in the three groups of patients were 462 (15--50 850), 189 (<15--38 300) and 91 (<10--13 750) pg/mL, respectively (p<0.01). The corresponding TNF-alpha plasma levels were 37.5 (<15--2400), 15 (<15--240) and 15 (<15--200) pg/mL, respectively (p<0.01). CRP plasma levels were 10.7 (<0.6--30.2), 10.3 (<0.6--34.4) and 7.3 (<0.6--20.9) mg/dL, respectively (p=0.12). With respect to these three parameters, IL-6 and TNF-alpha appear better than CRP for predicting bacteremia. Clinical features resulted in starting empirical antimicrobial therapy in only 62% of the bacteremic patients. On the other hand, 68% of these bacteremic patients had high IL-6 plasma levels (>200 pg/mL). A combination of clinical features and high IL-6 levels would have permitted early treatment for 82% of the bacteremic patients. CONCLUSIONS: IL-6 and TNF-alpha thus appear to be useful and earlier markers of bacteremia in septic patients. By contrast, CRP is neither sensitive nor specific in this setting.

show abstract

Predicting bacteremia based on nurse‐assessed food consumption at the time of blood culture

Komatsu

Onda

Murayama

et al. 2012

Journal of Hospital Medicine

View full text Add to dashboard Cite

BACKGROUND:Bacteremia and its complications are important causes of morbidity and mortality in hospitalized patients. However, the yield of blood cultures is relatively low, with many false‐positive results from bacterial contamination.METHODS:We investigated the relationship between patient food consumption and the presence of bacteremia. This was an observational analysis of a cohort of 1179 patients who underwent blood culture analysis between January 2005 and December 2009. Patients with anorexia‐inducing conditions, such as gastrointestinal illness and malignant disease treated with chemotherapy, were excluded. Food consumption was rated by nurses as the percentage of food consumed during the meal preceding the blood culture. Groupings were as follows: low consumption (<50%), moderate (>50% to <80%), and high (>80%).RESULTS:Low consumption was observed in 39.8% of patients, moderate in 17.8%, and high in 41.6%. The average body temperature was 38.1 ± 1.1°C. Bacteremia was present in 18.5%, 3.9%, and 1.4% of patients in the low, moderate, and high food consumption groups, respectively. The negative predictive value was 98.3%, suggesting that bacteremia is very unlikely in the setting of good food intake.CONCLUSION:Bacteremia is an unlikely occurrence in hospitalized patients who maintain adequate food consumption at the time of blood culture. Journal of Hospital Medicine 2012. © 2012 Society of Hospital Medicine

show abstract

Bacteremia in Febrile Patients

Cited by 88 publications

References 18 publications

Shaking chills and high body temperature predict bacteremia especially among elderly patients

Shaking chills and high body temperature predict bacteremia especially among elderly patients

Evaluation of tumor necrosis factor-α, interleukin-6 and C-reactive protein plasma levels as predictors of bacteremia in patients presenting signs of sepsis without shock

Predicting bacteremia based on nurse‐assessed food consumption at the time of blood culture

Contact Info

Product

Resources

About