Inadequacy of Temperature and White Blood Cell Count in Predicting Bacteremia in Patients with Suspected Infection

Seigel, Todd A.; Cocchi, Michael N.; Salciccioli, Justin D.; Shapiro, Nathan I.; Howell, Michael D.; Tang, Amy; Donnino, Michael W.

doi:10.1016/j.jemermed.2010.05.038

Cited by 86 publications

(61 citation statements)

References 18 publications

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“…28 Thrombocytopenia at presentation was also less pronounced in patients with bacterial coinfection. Because platelet counts in dengue fall progressively until a nadir at days 5 and 6 of illness, 29,30 this finding can be explained by patients with more severe illness presenting earlier.…”

Section: Discussionmentioning

confidence: 99%

Identification of Concurrent Bacterial Infection in Adult Patients with Dengue

See¹,

Phua²,

Yip³

et al. 2013

The American Journal of Tropical Medicine and Hygiene

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Abstract. We aim to construct a diagnostic model for bacterial coinfection in dengue patients (Dengue Dual Infection Score [DDIS]); 2,065 adult dengue patients (mean age = 41.9 ± 17.2 years, 58.4% male, 83 patients with bacterial coinfection) seen at a university hospital from January of 2005 to February of 2010 were studied. The DDIS was created by assigning one point to each of five risk factors for bacterial coinfection: pulse rate 90 beats/minute, total white cell count 6 + 10 9 /L, hematocrit 40%, serum sodium 135 mmol/L, and serum urea 5 mmol/L. The DDIS identified bacterial coinfection (derivation set area under the curve = 0.793, 95% confidence interval = 0.732-0.854; validation set area under the curve = 0.761, 95% confidence interval = 0.637-0.886). A DDIS of 4 had a specificity of 94.4%, whereas a DDIS of 1 had a sensitivity of 94.4% for bacterial coinfection. The DDIS can help to select dengue patients for early bacterial cultures and empirical antibiotics.

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Section: Discussionmentioning

confidence: 99%

Identification of Concurrent Bacterial Infection in Adult Patients with Dengue

See¹,

Phua²,

Yip³

et al. 2013

The American Journal of Tropical Medicine and Hygiene

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“…Fever as a classic symptom of septic patients has minor sensitivity and specificity in relation to diagnostic expressiveness [140,141] . Drewry et al [142] showed that abnormal body temperature curves were predictive of the diagnosis of sepsis in afebrile critically ill patients.…”

Section: Body Temperature Patternsmentioning

confidence: 99%

Are there new approaches for diagnosis, therapy guidance and outcome prediction of sepsis?

Kojic

Siegler

Uhle

et al. 2015

WJEM

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Beside many efforts to improve outcome, sepsis is still one of the most frequent causes of death in critically ill patients. It is the most common condition with high mortality in intensive care units. The complexity of the septic syndrome comprises immunological aspects -i.e. , sepsis induced immunosuppression -but is not restricted to this fact in modern concepts. So far, exact mechanisms and variables determining outcome and mortality stay unclear. Since there is no typical risk profile, early diagnosis and risk stratification remain difficult, which hinders rapid and effective treatment initiation. Due to the heterogeneous nature of sepsis, potential therapy options should be adapted to the individual. Biomarkers like C-reactive protein and procalcitonin are routinely used as complementary tools in clinical decision-making. Beyond the acute phase proteins, a wide bunch of promising substances and non-laboratory tools with potential diagnostic and prognostic value is under intensive investigation. So far, clinical decision just based on biomarker assessment is not yet feasible. However, biomarkers should be considered as a complementary approach. Core tip: Sepsis is a complex continuum of disturbed systems. Despite the presence of clinical consensus criteria, the early diagnosis especially in the perioperative setting is challenging. A magnitude of potential new biomarkers is tested for this purpose, but evidence is mounting that due to the complex nature of the syndrome, biomarkers are rather complementary tools for clinical decision making than "magic bullets". Moreover, biomarkers are also evaluated for therapy guidance, linking diagnostic results to an individual therapeutic regime. This review summarizes the developments in the biomarker field, aiming to provide an overview about current targets and their limitations.

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“…Some studies go further to suggest that bandemia is a superior indicator of infection relative to both WBC and temperature as bandemia was initially present in 80% of patients who did not present with elevated WBC or temperatures and were later found to be bacteremic [11]. Another study reports that the sensitivity of band counts was greater than that of either WBC or absolute neutrophil count (ANC) specifically for at-risk populations such as infants and elderly patients [12,13].…”

Section: Introductionmentioning

confidence: 99%

“…However, there are currently no clinical standards by which otherwise healthy-appearing patients with isolated bandemia should be treated with antibiotics, let alone admitted to the hospital. Previous studies have focused mainly on determining whether the band count is of quantitative value; however, there is inconsistency in defining a single standard to determine what constitutes an elevated band count, with thresholds ranging from ≥5% to ≥20% [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of ED patients with bandemia

Shi¹,

Vilke²,

Coyne³

et al. 2015

The American Journal of Emergency Medicine

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Background: Although an elevated white blood cell count is a widely utilized measure for evidence of infection and an important criterion for evaluation of systemic inflammatory response syndrome, its component band count occupies a more contested position within clinical emergency medicine. Recent studies indicate that bandemia is highly predictive of a serious infection, suggesting that clinicians who do not appreciate the value of band counts may delay diagnosis or overlook severe infections. Objectives: Whereas previous studies focused on determining the quantitative value of the band count (ie, determining sensitivity, threshold for bandemia, etc.), this study directs attention to patient-centered outcomes, hypothesizing that the degree of bandemia predisposes patients to subsequent negative clinical outcomes associated with underappreciated severe infections. Methods: This retrospective study of electronic medical records includes patients who initially presented to the emergency department (ED) with bandemia and were subsequently discharged from the ED. These patients were screened for repeat ED visits within 7 days and death within 30 days. Results: In patients with severe bandemia who were discharged from the ED, there was a 20.9% revisit rate at 7 days and a 4.9% mortality rate at 30 days, placing severely bandemic patients at 5 times significantly greater mortality compared to nonbandemic patients (P = .032). Conclusion: Our review of patient outcomes suggests that the degree of bandemia, especially in the setting of concurrent tachycardia or fever, is associated with greater likelihood of negative clinical outcomes.

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Inadequacy of Temperature and White Blood Cell Count in Predicting Bacteremia in Patients with Suspected Infection

Cited by 86 publications

References 18 publications

Identification of Concurrent Bacterial Infection in Adult Patients with Dengue

Identification of Concurrent Bacterial Infection in Adult Patients with Dengue

Are there new approaches for diagnosis, therapy guidance and outcome prediction of sepsis?

Clinical outcomes of ED patients with bandemia

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