Langius Phoebe, Perez Donny, Lopez Sandra, Boccio Eric
Emergency Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA.
Emergency Medicine, Memorial Healthcare System, Hollywood, USA.
Cureus. 2024 Oct 28;16(10):e72561. doi: 10.7759/cureus.72561. eCollection 2024 Oct.
Background Community-acquired bacteremia is a potential source of infection and cause of fever in patients presenting to the emergency department (ED) with suspected sepsis. Ambiguous or false-positive blood culture results may lead to unnecessary testing and overtreatment with substantial implications on antimicrobial stewardship and associated healthcare costs. There is little clinical information available to determine with a high degree of certainty whether a patient may be febrile secondary to bacteremia. The primary aim of this study was to assess the diagnostic utility of fever in patients with suspected sepsis secondary to community-acquired bacteremia. Methodology A retrospective review of a consecutive sample of electronic health records of patients presenting to the ED of an academic tertiary care hospital with an annual census of approximately 100,000 visits was performed. Structured demographic and clinical data were summarized. Receiver operating characteristics of fever, defined as an initial recorded temperature ≥38°C, in predicting bacteremia, defined as at least one positive blood culture result, were calculated. The associations between fever and bacteremia and admission and inpatient all-cause mortality rates were analyzed using multivariable logistic regression. Results A total of 100,270 pediatric and adult ED visits were screened for eligibility. Of the 10,220 (10.2%) patients who had at least one blood culture result and temperature recorded, 1,175 (11.5%) were febrile and 487 (4.8%) had bacteremia. Febrile patients were more likely to have blood cultures drawn than afebrile patients (34% vs. 10%, p < 0.001), and the median initial temperature was higher in patients with a positive blood culture result (37.1°C vs. 36.9°C, p < 0.001). Fever was not sensitive for bacteremia across pediatric, adult, and geriatric cohorts (25.0%, 21.6%, and 23.4%, respectively), but was more specific in adult and geriatric cohorts (90.2% and 92.1%, respectively) than the pediatric cohort (68.6%). A positive blood culture result was associated with an increased likelihood of admission (adjusted odds ratio (AOR) = 2.85, 95% confidence interval (CI) = 2.14-3.81, p < 0.001) and inpatient all-cause mortality (AOR = 3.67, 95% CI = 2.68-5.04, p < 0.001) while fever increased the likelihood of admission only (AOR = 1.58, 95% CI = 1.36-1.83, p < 0.001). Conclusions A strict definition of a fever of ≥38°C is specific but not sensitive for bacteremia. Febrile patients are 1.58 times as likely to be admitted when compared to afebrile patients while adjusting for age, sex, and the presence of a positive blood culture result. Bacteremia is associated with increased admission and mortality rates in patients with suspected sepsis presenting to the ED.
社区获得性菌血症是急诊科（ED）疑似脓毒症患者潜在的感染源和发热原因。血培养结果不明确或呈假阳性可能导致不必要的检查和过度治疗，对抗菌药物管理及相关医疗费用有重大影响。几乎没有临床信息可用于高度确定患者发热是否继发于菌血症。本研究的主要目的是评估发热对疑似社区获得性菌血症继发脓毒症患者的诊断效用。
对一家年就诊量约100,000人次的学术性三级护理医院急诊科患者的电子健康记录连续样本进行回顾性分析。汇总结构化的人口统计学和临床数据。计算发热（定义为初始记录体温≥38°C）在预测菌血症（定义为至少一次血培养结果呈阳性）方面的受试者工作特征曲线。使用多变量逻辑回归分析发热与菌血症以及入院和住院全因死亡率之间的关联。
共筛选了100,270例儿科和成人急诊科就诊病例以确定其是否符合条件。在至少有一次血培养结果并记录了体温的10,220例（10.2%）患者中，1,175例（11.5%）发热，487例（4.8%）有菌血症。发热患者比不发热患者更有可能进行血培养（34%对10%，p<0.001），血培养结果呈阳性的患者初始体温中位数更高（37.1°C对36.9°C，p<0.001）。在儿科、成人和老年队列中，发热对菌血症均不敏感（分别为25.0%、21.6%和23.4%），但在成人和老年队列中比儿科队列更具特异性（分别为90.2%和92.1%对68.6%）。血培养结果呈阳性与入院可能性增加（调整优势比（AOR）=2.85，95%置信区间（CI）=2.14 - 3.81，p<0.ooo1）和住院全因死亡率增加（AOR = 3.67，95%CI = 2.68 - 5.04，p<0.001）相关，而发热仅增加入院可能性（AOR = 1.58，95%CI = 1.36 - 1.83，p<0.001）。
严格定义的≥38°C发热对菌血症具有特异性但不敏感。在调整年龄、性别和血培养结果呈阳性的因素后，发热患者入院的可能性是不发热患者的1.58倍。菌血症与急诊科疑似脓毒症患者的入院率和死亡率增加相关。
