Risk factors and outcomes of afebrile bacteremia patients in an emergency department

Yo, Chia‐Hung; Lee, Meng-tse Gabriel; Hsein, Yenh-Chen; Lee, Chien‐Chang

doi:10.1016/j.diagmicrobio.2016.08.020

Cited by 21 publications

(38 citation statements)

References 21 publications

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“…The 30-day mortality in our afebrile bacteremic group was substantially high (40%), and was similar to a previous afebrile bacteremia study (10). This could be attributed to their higher proportion of inappropriate antibiotics treatment since timely and adequate antimicrobial therapy was still considered as an important prognostic factor in cirrhotic bacteremic patients, regardless of their comorbidities or infection severity (11,30,32).…”

Section: Although the Prognosis And Survival Of Patients Between Alcosupporting

confidence: 86%

“…Cirrhotic patients may have hypersplenism, use beta-blockers, and present leukopenia and bradycardia, thus showing a lack of SIRS parameters (28,29). In concurrence with this hypothesis, more than half of our afebrile bacteremic patients presented absence of tachycardia or leukocytosis, which further lowered warning level for clinicians, thereby dismissing infectious diseases (9,10). It had been proposed that markers of organ dysfunction rather than inflammatory variables, have better prognosis impact and mortality prediction performance in cirrhotic patients with sepsis (27).…”

Section: Although the Prognosis And Survival Of Patients Between Alcosupporting

confidence: 57%

“…Clinicians frequently rely on the presence of fever to initiate infection workup (7); however, fever is a complex and nonspecific host defense response against infection, and not an indispensable component of the bacteremic syndrome (8). Afebrile bacteremic patients often have atypical clinical manifestations, such as lethargy or confusion (9), leading to decreased survival and poorer prognosis (10).…”

Section: Introductionmentioning

confidence: 99%

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Afebrile Bacteremia in Adult Emergency Department Patients with Liver Cirrhosis：Clinical Characteristics and Outcomes

Chen

Hsu

2019

Preprint

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Background: Cirrhotic patients with bacteremia are at an increased risk of organ failure and mortality. In addition, they can develop serious infection without fever because of their impaired immune response. Our study aimed to investigate the clinical characteristics, and outcomes in afebrile bacteremic patients with liver cirrhosis. Methods: A single-center, retrospective cohort study was performed on adult patients who visited the emergency department from January 2015 to December 2018. All patients with bacteremia and a diagnosis of liver cirrhosis were enrolled and classified as either afebrile or febrile. We compared the clinical characteristics, laboratory results, microbiological data and outcomes between the two groups. Results：In total, 113 bacteremic patient with liver cirrhosis (afebrile: 60 patients and, febrile: 53) were included in the study. Compared with the febrile group, patients in the afebrile group showed a significantly higher rate of inappropriate antimicrobial agent administration (43.3% vs. 18.9%, p= 0.01). They were also at an increased risk of 30-day mortality (40% vs. 18.9%, p= 0.02), intensive care unit transfer (38.3% vs. 20.8%, p=0.04) and endotracheal intubation (28.3% vs. 11.3%, p=0.03). Conclusions：In bacteremic patients with liver cirrhosis, a significantly higher rate of inappropriate antimicrobial agent administration, higher risk of intensive care unit transfer, endotracheal intubation and 30-day mortality were observed in the afebrile group than in the febrile group. Clinicians should perform prudent evaluation in cirrhotic patients and carefully monitor for possible sings of serious infection even in the absence of fever.

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Section: Although the Prognosis And Survival Of Patients Between Alcosupporting

confidence: 86%

Section: Although the Prognosis And Survival Of Patients Between Alcosupporting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

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Afebrile Bacteremia in Adult Emergency Department Patients with Liver Cirrhosis：Clinical Characteristics and Outcomes

Chen

Hsu

2019

Preprint

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“…Each hour delay in antibiotic administration is associated with increased mortality. 22 It is not surprising that afebrile bacteremia is associated with worse outcomes 9 , as septic patients presenting without fever are more likely to experience diagnostic and treatment delays.…”

Section: Discussionmentioning

confidence: 99%

“…Our analysis of patients' temperature was limited to their assessment at ED triage. It is likely that patients' temperatures fluctuate throughout hospitalization, and as such, other studies have looked at the presence of fever throughout the ED course 9 or 24 hours prior to blood culture acquisition 10 . Nonetheless, ED triage serves as the first point of contact in the hospital setting, and the high prevalence of afebrile bacteremic patients at triage raises important concerns, given the association between afebrile bacteremia and diagnostic delay 8 .…”

Section: Discussionmentioning

confidence: 99%

Do Bacteremic Patients with End-Stage Renal Disease Have a Fever When Presenting to The Emergency Department? A Paired, Retrospective Cohort Study.

Weatherall

Chambers

Mermel

2019

Preprint

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Background Fever is a common symptom when patients present to Emergency Departments. It is unclear if the febrile response of bacteremic hemodialysis-dependent patients differs from bacteremic patients not receiving hemodialysis. The objective of this study was to compare Emergency Departments triage temperatures of patients with and without hemodialysis-dependent end-stage rental disease who have Staphylococcus aureus bacteremia and determine the incidence of afebrile S. aureus bacteremia. Methods: Paired, retrospective cohort study of 37 patients with and 37 patients without hemodialysis hospitalized with Methicillin-resistant or Methicillin-susceptible S. aureus bacteremia. Emergency Department triage temperatures were reviewed for all patients, as were potential confounding variables. Results: 54% (95% CI, 38-70%) and 82% (95% CI 65-91%) of hemodialysis and non-hemodialysis patients did not have a detectable fever (<100.4°F) at triage. Triage temperatures were 100.5°F (95% CI 99.9-101.2°F) and 99.0°F (95% CI 98.4-99.6°F) in the hemodialysis and non-hemodialysis cohorts, respectively (p<0.001). Triage temperature in patients with and without diabetes mellitus was 99.2°F (95% CI 98.4-99.9°F) and 100.4°F (95% CI 99.7-101.0°F), respectively (p=0.03). We were unable to detect a significant effect of diabetes mellitus and other potential confounding variables on differences in temperature between the hemodialysis and non-hemodialysis cohorts (all interactions p > 0.19). Conclusions: Hemodialysis-dependent patients with S. aureus bacteremia had significantly higher temperatures than non- hemodialysis-dependent end stage renal disease patients but more than half of patients were without detectable fever at triage, possibly reflecting use of insensitive methods for measuring temperature. Absence of fever at presentation to the Emergency Department should not delay blood culture acquisition in patients who are at increased risk of S. aureus bacteremia.

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Atypical Presentation of Bacteremia in Older Patients Is a Risk Factor for Death

Hyernard

Breining

Duc

et al. 2019

The American Journal of Medicine

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Risk factors and outcomes of afebrile bacteremia patients in an emergency department

Cited by 21 publications

References 21 publications

Afebrile Bacteremia in Adult Emergency Department Patients with Liver Cirrhosis：Clinical Characteristics and Outcomes

Afebrile Bacteremia in Adult Emergency Department Patients with Liver Cirrhosis：Clinical Characteristics and Outcomes

Do Bacteremic Patients with End-Stage Renal Disease Have a Fever When Presenting to The Emergency Department? A Paired, Retrospective Cohort Study.

Atypical Presentation of Bacteremia in Older Patients Is a Risk Factor for Death

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