Rate and Predictors of Bacteremia in Afebrile Community-Acquired Pneumonia
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 characterist...
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| Vydáno v: | Chest Ročník 157; číslo 3; s. 529 |
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01.03.2020
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| Abstract | 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.
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.
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.
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. |
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| AbstractList | 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.
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.
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.
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. 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.BACKGROUNDAlthough 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.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.METHODSBacteremia 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.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.RESULTSBacteremic 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.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.CONCLUSIONSA 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. |
| Author | Rohde, Gernot Patchev, Vladimir Pletz, Mathias W Rupp, Jan Witzenrath, Martin Burgmann, Heinz Welte, Tobias Forstner, Christina |
| Author_xml | – sequence: 1 givenname: Christina surname: Forstner fullname: Forstner, Christina email: christina.forstner@med.uni-jena.de organization: Institute of Infectious Diseases and Infection Control, University Hospital, Jena, Germany; Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria. Electronic address: christina.forstner@med.uni-jena.de – sequence: 2 givenname: Vladimir surname: Patchev fullname: Patchev, Vladimir organization: Institute of Infectious Diseases and Infection Control, University Hospital, Jena, Germany – sequence: 3 givenname: Gernot surname: Rohde fullname: Rohde, Gernot organization: Medical Department I, Department of Respiratory Medicine, Goethe University Hospital, Frankfurt/Main, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL); CAPNETZ Stiftung, Hannover, Germany – sequence: 4 givenname: Jan surname: Rupp fullname: Rupp, Jan organization: CAPNETZ Stiftung, Hannover, Germany; Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany; German Center for Infection Research (DZIF), partner site Hamburg-Lübeck-Borstel-Riems, Lübeck, Germany – sequence: 5 givenname: Martin surname: Witzenrath fullname: Witzenrath, Martin organization: CAPNETZ Stiftung, Hannover, Germany; Department of Infectious Diseases and Pulmonary Medicine and the Division of Pulmonary Inflammation, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany – sequence: 6 givenname: Tobias surname: Welte fullname: Welte, Tobias organization: Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL); CAPNETZ Stiftung, Hannover, Germany; Department of Pneumology, Hannover Medical School, Hannover, Germany – sequence: 7 givenname: Heinz surname: Burgmann fullname: Burgmann, Heinz organization: Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria – sequence: 8 givenname: Mathias W surname: Pletz fullname: Pletz, Mathias W organization: Institute of Infectious Diseases and Infection Control, University Hospital, Jena, Germany; CAPNETZ Stiftung, Hannover, Germany |
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| Copyright | Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. |
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| References | 32892865 - Chest. 2020 Sep;158(3):1284 32892866 - Chest. 2020 Sep;158(3):1284-1285 |
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| SubjectTerms | Aged Bacteremia - epidemiology 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 Fever - epidemiology Haemophilus Infections - epidemiology Haemophilus Infections - metabolism Humans Hypothermia - epidemiology Klebsiella Infections - epidemiology Klebsiella Infections - metabolism Logistic Models Male Middle Aged Mortality Pneumonia - epidemiology 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 |
| Title | Rate and Predictors of Bacteremia in Afebrile Community-Acquired Pneumonia |
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