Prediction of community-onset bacteremia among febrile adults visiting an emergency department: Rigor matters

Ching Chi Lee, Chi Jung Wu, Chih-Hsien Chi, Nan-Yao Lee, Po-Lin Chen, Hsin Chun Lee, Chia-Ming Chang, Nai-Ying Ko, Wen-Chien Ko

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objectives: Bacteremia is a severe bacterial infection with significant mortality and morbidity. Clinical parameters that reliably predict the presence of community-onset bacteremia are less elucidated. Methods: During 96 randomly selected days between August 2006 and July 2007, a prospective study was conducted to analyze the risk factors of community-onset bacteremia among febrile adults who visited the emergency department (ED) of a medical center. Patients hospitalized in the 30 days prior to the study, patients experiencing consciousness alteration, and nursing facility residents were excluded. Results: The mean age of the 396 febrile adults enrolled in the study was 53.8 years (range, 18-95 years), and 60 (15.2%) patients had true bacteremia, with the predominance of monomicrobial Gram-negative pathogens (42 patients). In a multivariate analysis, several factors were independently associated with community-onset bacteremia, including an age of >65 years (odds ratio [OR], 2.81; 95% confidence interval [CI], 1.25-6.33), the presence of rigor (OR, 13.7; 95% CI, 4.47-42.0) or chills (OR, 6.04; 95% CI, 1.10-32.9), a body temperature >39.9 °C (OR, 2.68; 95% CI, 1.03-6.94), blood urea nitrogen >20 mg/dL (OR, 5.56; 95% CI, 2.03-15.7), a blood urea nitrogen/creatinine ratio >16 (OR, 2.29; 95% CI, 1.03-5.11), and thrombocytopenia (OR, 6.09; 95% CI, 1.84-20.0). After scoring each risk factor, a logistic regression model for the prediction of bacteremia was developed, and the area under the receiver operating characteristic curve was 0.91. Conclusions: Some easily determined clinical parameters were independently associated with community-onset bacteremia among febrile adults, and the most significant predictor was the presence of rigor. Although the proposed predictive model needs further validation, it may be of use for the early identification of bacteremic episodes in ED practice.

Original languageEnglish
Pages (from-to)168-173
Number of pages6
JournalDiagnostic Microbiology and Infectious Disease
Volume73
Issue number2
DOIs
Publication statusPublished - 2012 Jun 1

Fingerprint

Bacteremia
Hospital Emergency Service
Fever
Odds Ratio
Confidence Intervals
Blood Urea Nitrogen
Logistic Models
Chills
Body Temperature
Consciousness
Bacterial Infections
ROC Curve
Thrombocytopenia
Creatinine
Nursing
Multivariate Analysis
Prospective Studies
Morbidity
Mortality

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

Cite this

@article{209830461f544c4cbc48f8d626152e78,
title = "Prediction of community-onset bacteremia among febrile adults visiting an emergency department: Rigor matters",
abstract = "Objectives: Bacteremia is a severe bacterial infection with significant mortality and morbidity. Clinical parameters that reliably predict the presence of community-onset bacteremia are less elucidated. Methods: During 96 randomly selected days between August 2006 and July 2007, a prospective study was conducted to analyze the risk factors of community-onset bacteremia among febrile adults who visited the emergency department (ED) of a medical center. Patients hospitalized in the 30 days prior to the study, patients experiencing consciousness alteration, and nursing facility residents were excluded. Results: The mean age of the 396 febrile adults enrolled in the study was 53.8 years (range, 18-95 years), and 60 (15.2{\%}) patients had true bacteremia, with the predominance of monomicrobial Gram-negative pathogens (42 patients). In a multivariate analysis, several factors were independently associated with community-onset bacteremia, including an age of >65 years (odds ratio [OR], 2.81; 95{\%} confidence interval [CI], 1.25-6.33), the presence of rigor (OR, 13.7; 95{\%} CI, 4.47-42.0) or chills (OR, 6.04; 95{\%} CI, 1.10-32.9), a body temperature >39.9 °C (OR, 2.68; 95{\%} CI, 1.03-6.94), blood urea nitrogen >20 mg/dL (OR, 5.56; 95{\%} CI, 2.03-15.7), a blood urea nitrogen/creatinine ratio >16 (OR, 2.29; 95{\%} CI, 1.03-5.11), and thrombocytopenia (OR, 6.09; 95{\%} CI, 1.84-20.0). After scoring each risk factor, a logistic regression model for the prediction of bacteremia was developed, and the area under the receiver operating characteristic curve was 0.91. Conclusions: Some easily determined clinical parameters were independently associated with community-onset bacteremia among febrile adults, and the most significant predictor was the presence of rigor. Although the proposed predictive model needs further validation, it may be of use for the early identification of bacteremic episodes in ED practice.",
author = "Lee, {Ching Chi} and Wu, {Chi Jung} and Chih-Hsien Chi and Nan-Yao Lee and Po-Lin Chen and Lee, {Hsin Chun} and Chia-Ming Chang and Nai-Ying Ko and Wen-Chien Ko",
year = "2012",
month = "6",
day = "1",
doi = "10.1016/j.diagmicrobio.2012.02.009",
language = "English",
volume = "73",
pages = "168--173",
journal = "Diagnostic Microbiology and Infectious Disease",
issn = "0732-8893",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Prediction of community-onset bacteremia among febrile adults visiting an emergency department

T2 - Rigor matters

AU - Lee, Ching Chi

AU - Wu, Chi Jung

AU - Chi, Chih-Hsien

AU - Lee, Nan-Yao

AU - Chen, Po-Lin

AU - Lee, Hsin Chun

AU - Chang, Chia-Ming

AU - Ko, Nai-Ying

AU - Ko, Wen-Chien

PY - 2012/6/1

Y1 - 2012/6/1

N2 - Objectives: Bacteremia is a severe bacterial infection with significant mortality and morbidity. Clinical parameters that reliably predict the presence of community-onset bacteremia are less elucidated. Methods: During 96 randomly selected days between August 2006 and July 2007, a prospective study was conducted to analyze the risk factors of community-onset bacteremia among febrile adults who visited the emergency department (ED) of a medical center. Patients hospitalized in the 30 days prior to the study, patients experiencing consciousness alteration, and nursing facility residents were excluded. Results: The mean age of the 396 febrile adults enrolled in the study was 53.8 years (range, 18-95 years), and 60 (15.2%) patients had true bacteremia, with the predominance of monomicrobial Gram-negative pathogens (42 patients). In a multivariate analysis, several factors were independently associated with community-onset bacteremia, including an age of >65 years (odds ratio [OR], 2.81; 95% confidence interval [CI], 1.25-6.33), the presence of rigor (OR, 13.7; 95% CI, 4.47-42.0) or chills (OR, 6.04; 95% CI, 1.10-32.9), a body temperature >39.9 °C (OR, 2.68; 95% CI, 1.03-6.94), blood urea nitrogen >20 mg/dL (OR, 5.56; 95% CI, 2.03-15.7), a blood urea nitrogen/creatinine ratio >16 (OR, 2.29; 95% CI, 1.03-5.11), and thrombocytopenia (OR, 6.09; 95% CI, 1.84-20.0). After scoring each risk factor, a logistic regression model for the prediction of bacteremia was developed, and the area under the receiver operating characteristic curve was 0.91. Conclusions: Some easily determined clinical parameters were independently associated with community-onset bacteremia among febrile adults, and the most significant predictor was the presence of rigor. Although the proposed predictive model needs further validation, it may be of use for the early identification of bacteremic episodes in ED practice.

AB - Objectives: Bacteremia is a severe bacterial infection with significant mortality and morbidity. Clinical parameters that reliably predict the presence of community-onset bacteremia are less elucidated. Methods: During 96 randomly selected days between August 2006 and July 2007, a prospective study was conducted to analyze the risk factors of community-onset bacteremia among febrile adults who visited the emergency department (ED) of a medical center. Patients hospitalized in the 30 days prior to the study, patients experiencing consciousness alteration, and nursing facility residents were excluded. Results: The mean age of the 396 febrile adults enrolled in the study was 53.8 years (range, 18-95 years), and 60 (15.2%) patients had true bacteremia, with the predominance of monomicrobial Gram-negative pathogens (42 patients). In a multivariate analysis, several factors were independently associated with community-onset bacteremia, including an age of >65 years (odds ratio [OR], 2.81; 95% confidence interval [CI], 1.25-6.33), the presence of rigor (OR, 13.7; 95% CI, 4.47-42.0) or chills (OR, 6.04; 95% CI, 1.10-32.9), a body temperature >39.9 °C (OR, 2.68; 95% CI, 1.03-6.94), blood urea nitrogen >20 mg/dL (OR, 5.56; 95% CI, 2.03-15.7), a blood urea nitrogen/creatinine ratio >16 (OR, 2.29; 95% CI, 1.03-5.11), and thrombocytopenia (OR, 6.09; 95% CI, 1.84-20.0). After scoring each risk factor, a logistic regression model for the prediction of bacteremia was developed, and the area under the receiver operating characteristic curve was 0.91. Conclusions: Some easily determined clinical parameters were independently associated with community-onset bacteremia among febrile adults, and the most significant predictor was the presence of rigor. Although the proposed predictive model needs further validation, it may be of use for the early identification of bacteremic episodes in ED practice.

UR - http://www.scopus.com/inward/record.url?scp=84862788948&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84862788948&partnerID=8YFLogxK

U2 - 10.1016/j.diagmicrobio.2012.02.009

DO - 10.1016/j.diagmicrobio.2012.02.009

M3 - Article

C2 - 22463870

AN - SCOPUS:84862788948

VL - 73

SP - 168

EP - 173

JO - Diagnostic Microbiology and Infectious Disease

JF - Diagnostic Microbiology and Infectious Disease

SN - 0732-8893

IS - 2

ER -