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Rate and Predictors of Bacteremia in Afebrile Community-Acquired Pneumonia.
- Source :
-
Chest [Chest] 2020 Mar; Vol. 157 (3), pp. 529-539. Date of Electronic Publication: 2019 Oct 26. - Publication Year :
- 2020
-
Abstract
- Background: Although blood cultures (BCs) are the "gold standard" for detecting bacteremia, the utility of BCs in patients with community-acquired pneumonia (CAP) is controversial. This study describes the proportion of patients with CAP and afebrile bacteremia and identifies the clinical characteristics predicting the necessity for BCs in patients who are afebrile.<br />Methods: Bacteremia rates were determined in 4,349 patients with CAP enrolled in the multinational cohort study The Competence Network of Community-Acquired Pneumonia (CAPNETZ) and stratified by presence of fever at first patient contact. Independent predictors of bacteremia in patients who were afebrile were determined using logistic regression analysis.<br />Results: Bacteremic pneumonia was present in 190 of 2,116 patients who were febrile (8.9%), 101 of 2,149 patients who were afebrile (4.7%), and one of 23 patients with hypothermia (4.3%). Bacteremia rates increased with the CURB-65 score from 3.5% in patients with CURB-65 score of 0 to 17.1% in patients with CURB-65 score of 4. Patients with afebrile bacteremia exhibited the highest 28-day mortality rate (9.9%). Positive pneumococcal urinary antigen test (adjusted OR [AOR], 4.6; 95% CI, 2.6-8.2), C-reactive protein level > 200 mg/L (AOR, 3.1; 95% CI, 1.9-5.2), and BUN level ≥ 30 mg/dL (AOR, 3.1; 95% CI, 1.9-5.3) were independent positive predictors, and antibiotic pretreatment (AOR, 0.3; 95% CI, 0.1-0.6) was an independent negative predictor of bacteremia in patients who were afebrile.<br />Conclusions: A relevant proportion of patients with bacteremic CAP was afebrile. These patients had an increased mortality rate compared with patients with febrile bacteremia or nonbacteremic pneumonia. Therefore, the relevance of fever as an indicator for BC necessity merits reconsideration.<br /> (Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Bacteremia metabolism
Blood Culture
Blood Urea Nitrogen
C-Reactive Protein metabolism
Cohort Studies
Community-Acquired Infections epidemiology
Escherichia coli Infections epidemiology
Escherichia coli Infections metabolism
Female
Haemophilus Infections epidemiology
Haemophilus Infections metabolism
Humans
Hypothermia epidemiology
Klebsiella Infections epidemiology
Klebsiella Infections metabolism
Logistic Models
Male
Middle Aged
Pneumonia metabolism
Pneumonia, Pneumococcal epidemiology
Pneumonia, Pneumococcal metabolism
Polysaccharides, Bacterial urine
Retrospective Studies
Risk Factors
Severity of Illness Index
Staphylococcal Infections epidemiology
Staphylococcal Infections metabolism
Streptococcal Infections epidemiology
Streptococcal Infections metabolism
Viridans Streptococci
Bacteremia epidemiology
Fever epidemiology
Mortality
Pneumonia epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1931-3543
- Volume :
- 157
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Chest
- Publication Type :
- Academic Journal
- Accession number :
- 31669433
- Full Text :
- https://doi.org/10.1016/j.chest.2019.10.006