Kim Wonhak, Kim So Mi, Yu Hoon, Jang Mun, Baek Seung Don, Kim Soon Bae
Division of Nephrology, Department of Internal Medicine, College of Medicine, University of Ulsan, Asan Medical Center, Seoul.
Division of Nephrology, Department of Internal Medicine, Dankook University Hospital, Cheonansi, South Korea.
Hemodial Int. 2018 Jan;22(1):119-125. doi: 10.1111/hdi.12548. Epub 2017 Mar 23.
We aimed to compare the in-hospital mortality between febrile and afebrile chronic hemodialysis (HD) patients with bacteremia and analyze the blood culture positive rate according to the C-reactive protein (CRP) level.
We collected data from 2006 to 2014. One hundred ninety bacteremic events were assigned to the "febrile group" (n = 162) and "afebrile group" (n = 28) based on the presence of fever. Fever was defined as a tympanic temperature >37.5°C or axillary temperature >37.0°C.
In-hospital mortality (41.4% vs. 6.1%) was higher; and the interval between admission and blood culture was longer (3 vs. 1 h) in the afebrile group than in the febrile group. The mean reason for blood culture in the afebrile group was a high CRP level.
An afebrile status in HD patients with bacteremia is associated with higher in-hospital mortality. Blood culture and empirical antibiotic administration, irrespective of the fever status, should be considered in HD patients with a CRP ≥ 5 mg/dL.
