Rate and Predictors of Bacteremia in Afebrile Community-Acquired Pneumonia.
Aged
Bacteremia
/ epidemiology
Blood Culture
Blood Urea Nitrogen
C-Reactive Protein
/ metabolism
Cohort Studies
Community-Acquired Infections
/ epidemiology
Escherichia coli Infections
/ epidemiology
Female
Fever
/ epidemiology
Haemophilus Infections
/ epidemiology
Humans
Hypothermia
/ epidemiology
Klebsiella Infections
/ epidemiology
Logistic Models
Male
Middle Aged
Mortality
Pneumonia
/ epidemiology
Pneumonia, Pneumococcal
/ epidemiology
Polysaccharides, Bacterial
/ urine
Retrospective Studies
Risk Factors
Severity of Illness Index
Staphylococcal Infections
/ epidemiology
Streptococcal Infections
/ epidemiology
Viridans Streptococci
bacteremia
community-acquired pneumonia (CAP)
fever
predictor
Journal
Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
received:
28
04
2019
revised:
03
09
2019
accepted:
04
10
2019
pubmed:
2
11
2019
medline:
21
10
2020
entrez:
1
11
2019
Statut:
ppublish
Résumé
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.
Sections du résumé
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.
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.
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.
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.
Identifiants
pubmed: 31669433
pii: S0012-3692(19)34102-9
doi: 10.1016/j.chest.2019.10.006
pii:
doi:
Substances chimiques
Polysaccharides, Bacterial
0
polysaccharide C-substance (Streptococcus)
0
C-Reactive Protein
9007-41-4
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
529-539Investigateurs
M Dreher
(M)
C Cornelissen
(C)
W Knüppel
(W)
D Stolz
(D)
N Suttorp
(N)
M Witzenrath
(M)
P Creutz
(P)
A Mikolajewska
(A)
T Bauer
(T)
D Krieger
(D)
W Pankow
(W)
D Thiemig
(D)
B Hauptmeier
(B)
S Ewig
(S)
D Wehde
(D)
M Prediger
(M)
S Schmager
(S)
M Kolditz
(M)
B Schulte-Hubbert
(B)
S Langner
(S)
W Albrich
(W)
T Welte
(T)
J Freise
(J)
G Barten
(G)
O Arenas Toro
(O)
M Nawrocki
(M)
J Naim
(J)
M Witte
(M)
W Kröner
(W)
T Illig
(T)
N Klopp
(N)
M Kreuter
(M)
F Herth
(F)
S Hummler
(S)
P Ravn
(P)
A Vestergaard-Jensen
(A)
G Baunbaek-Knudsen
(G)
M Pletz
(M)
C Kroegel
(C)
J Frosinski
(J)
J Winning
(J)
B Schleenvoigt
(B)
K Dalhoff
(K)
J Rupp
(J)
R Hörster
(R)
D Drömann
(D)
G Rohde
(G)
J Drijkoningen
(J)
D Braeken
(D)
H Buschmann
(H)
T Schaberg
(T)
I Hering
(I)
M Panning
(M)
M Wallner
(M)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.