The degree of chills for risk of bacteremia in acute febrile illness

Tokuda, Yasuharu; Miyasato, Hitoshi; Stein, Gerald H.; Kishaba, Tomokazu

doi:10.1016/j.amjmed.2005.06.043

Cited by 57 publications

(49 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Their procedural techniques were thought to be the most reliable and consistent in the latter half of their year of training. The presence of bacteremia was suspected on the basis of each patient's clinical findings, such as hyper-or hypothermia, shaking chills, acute distress, as well as other physical examination and laboratory findings (19,27).…”

Section: Methodsmentioning

confidence: 99%

Isopropyl Alcohol Compared with Isopropyl Alcohol plus Povidone-Iodine as Skin Preparation for Prevention of Blood Culture Contamination

et al. 2009

Self Cite

View full text Add to dashboard Cite

Despite a number of studies on the efficacies of antiseptics for the prevention of blood culture contamination, it still remains unclear which antiseptic should be used. Although the combination of povidone-iodine and isopropyl alcohol has been traditionally used in many institutions, the application of povidone-iodine needs extra time, and there is little evidence that this combination could have an additive effect in reducing contamination rates. To elucidate the additive efficacy of povidone-iodine, we compared two antiseptics, 70% isopropyl alcohol only and 70% isopropyl alcohol plus povidone-iodine, in a prospective, nonrandomized, and partially blinded study in a community hospital in Japan between 1 October 2007 and 21 March 2008. All blood samples for culture were drawn by first-year residents who received formal training on collection techniques. Skin antisepsis was performed with 70% isopropyl alcohol plus povidone-iodine on all inpatient wards and with only 70% isopropyl alcohol in the emergency department. For the group of specimens from inpatient wards cultured, 13 (0.46%) of 2,797 cultures were considered contaminated. For the group of specimens from the emergency department cultured, 12 (0.42%) of 2,856 cultures were considered contaminated. There was no significant difference in the contamination rates between the two groups (relative risk, 0.90; 95% confidence interval, 0.41 to 1.98; P ‫؍‬ 0.80). In conclusion, the use of a single application of 70% isopropyl alcohol is a sufficient and a more cost-and time-effective method of obtaining blood samples for culture than the use of a combination of isopropyl alcohol and povidone-iodine. The extremely low contamination rates in both groups suggest that the type of antiseptic used may not be as important as the use of proper technique.The collection of blood samples for culture is essential for the diagnosis and management of patients with suspected bacteremia, and the importance of this practice has recently been reconfirmed in the Clinical and Laboratory Standards Institute's guideline Principles and Procedure for Blood Cultures in 2007 (5). However, the problem of false-positive results due to contamination has remained since the beginning of the use of modern techniques over 70 years ago. Contamination most commonly occurs when exogenous bacteria are inoculated into the culture medium from the patient's skin, the phlebotomist's hands, or phlebotomy kits. Contamination rates below 3% are generally considered acceptable (5, 9). Nevertheless, the reported rates of contamination vary from 0.8% to over 8% among institutions. Almost half of all positive results were reported to be contaminants at some institutions (1,4,15,18,20,23,24,26,31). With such a high contamination rate, it is not easy to interpret the results properly for clinicians. Consequently, contaminated blood cultures lead to extra costs because of the unnecessary use of antibiotics, prolonged hospitalization, and the subsequent possible development of antimicrobial resistance (3,15,23,25...

show abstract

Section: Methodsmentioning

confidence: 99%

Isopropyl Alcohol Compared with Isopropyl Alcohol plus Povidone-Iodine as Skin Preparation for Prevention of Blood Culture Contamination

et al. 2009

Self Cite

View full text Add to dashboard Cite

show abstract

“…Clinical signs and laboratory tests included vital signs at presentation, laboratory data on admission, and diagnostic tests. We used qualitative degree criteria of chills based on our practice and classified them into the following; 1) "mild chills": feeling cold with equivalent of the need for an outer jacket, 2) "moderate chills": feeling very cold with equivalent of the need for a thick blanket, and, 3) "shaking chills": feeling extremely cold with rigor and generalized bodily shaking even under a thick blanket (16).…”

Section: Data Collectionmentioning

confidence: 99%

Diagnostic Performance of Pyogenic Vertebral Osteomyelitis

et al. 2007

Self Cite

View full text Add to dashboard Cite

Objective Early diagnosis of pyogenic vertebral osteomyelitis (PVO) is frequently difficult. There are, however, few studies that have investigated the diagnostic performance of PVO in Japan. Our aim was to analyze the diagnostic performance and identify clinical factors associated with the diagnostic delay of PVO. Materials and Methods We performed hospital-based retrospective case analysis. All patients with PVO were identified from the computerized medical database at Okinawa Chubu Hospital in Okinawa, Japan, from January 1985 to December 2004. We collected the following data; baseline information; laboratory tests; clinical and microbiologic outcomes; and diagnostic process. We used multivariable-adjusted linear regression to identify significant factors associated with patient and hospital delay to the diagnosis of PVO. Results We reviewed total of 209,428 patients hospitalized during the 20-year study period. Of those, we identified 51 patients with PVO. Eighty percent of these patients were misdiagnosed at their initial clinical encounters. Median duration from the symptom onset to the diagnosis was 19 days. Median durations of patient factor and hospital factor that contributed to the total delay were 1 and 8 days, respectively. Significant patient factor that contributed to delay was cognitive dysfunction. Conclusions Cognitive dysfunction is a risk factor for patient delay for visiting physicians in patients with PVO. Diagnosis of PVO is difficult at the initial clinical encounter. High index of suspicion is needed for more rapid diagnosis of PVO.

show abstract

“…However, the twice nightly drenching sweats also suggested the possible presence of a biquotidian fever, the differential diagnosis of which includes IE. The presence of chills, although not specific, also suggested the presence of bacteremia (25). A physical examination revealed the presence of a systemic inflammatory response syndrome, (26,27) hypotension and mucous membrane hemorrhages.…”

Section: Discussionmentioning

confidence: 99%

<i>Pasteurella multocida</i> Infective Endocarditis: A Possible Link with Primary Upper Respiratory Tract Infection

et al. 2015

View full text Add to dashboard Cite

A 50-year-old Japanese man presented with fever and upper respiratory tract symptoms that required urgent inpatient admission. A physical examination revealed conjunctival hemorrhages and peripheral embolic phenomena. Blood cultures grew Pasteurella multocida, and an echocardiography revealed a mitral valve vegetation suggestive of infective endocarditis (IE), which was confirmed using the Modified Duke Criteria. After several antibiotic regimens proved ineffective, valve replacement was performed, with a good eventual outcome. P. multocida IE is rare and may sometimes have no preceding risk factors. P. multocida infections of the upper respiratory tract are unusual but may be an inciting event for IE. It is essential to check blood cultures and to repeat the performance of physical examinations to appreciate the developing features of IE.

show abstract

The degree of chills for risk of bacteremia in acute febrile illness

Cited by 57 publications

References 25 publications

Isopropyl Alcohol Compared with Isopropyl Alcohol plus Povidone-Iodine as Skin Preparation for Prevention of Blood Culture Contamination

Isopropyl Alcohol Compared with Isopropyl Alcohol plus Povidone-Iodine as Skin Preparation for Prevention of Blood Culture Contamination

Diagnostic Performance of Pyogenic Vertebral Osteomyelitis

<i>Pasteurella multocida</i> Infective Endocarditis: A Possible Link with Primary Upper Respiratory Tract Infection

Contact Info

Product

Resources

About