Rate and Predictors of Bacteremia in Afebrile Community-Acquired Pneumonia
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Rate and Predictors of Bacteremia in Afebrile Community-Acquired Pneumonia. / Forstner, Christina; Patchev, Vladimir; Rohde, Gernot; Rupp, Jan; Witzenrath, Martin; Welte, T.; Burgmann, Heinz; Pletz, Mathias W.; Dreher, M.; Cornelissen, C.; Knüppel, W.; Stolz, D.; Suttorp, N.; Witzenrath, M.; Creutz, P.; Mikolajewska, A.; Bauer, T.; Krieger, D.; Pankow, W.; Thiemig, D.; Hauptmeier, B.; Ewig, S.; Wehde, D.; Prediger, M.; Schmager, S.; Kolditz, M.; Schulte-Hubbert, B.; Langner, S.; Albrich, W.; Welte, T.; Freise, J.; Barten, G.; Arenas Toro, O.; Nawrocki, M.; Naim, J.; Witte, M.; Kröner, W.; Illig, T.; Klopp, N.; Kreuter, M.; Herth, F.; Hummler, S.; Ravn, P.; Vestergaard-Jensen, A.; Baunbaek-Knudsen, G.; Pletz, M.; Kroegel, C.; Frosinski, J.; Winning, J.; Dalhoff, K.; CAPNETZ Study Group.
I: Chest, Bind 157, Nr. 3, 2020, s. 529-539.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Rate and Predictors of Bacteremia in Afebrile Community-Acquired Pneumonia
AU - Forstner, Christina
AU - Patchev, Vladimir
AU - Rohde, Gernot
AU - Rupp, Jan
AU - Witzenrath, Martin
AU - Welte, T.
AU - Burgmann, Heinz
AU - Pletz, Mathias W.
AU - Dreher, M.
AU - Cornelissen, C.
AU - Knüppel, W.
AU - Stolz, D.
AU - Suttorp, N.
AU - Witzenrath, M.
AU - Creutz, P.
AU - Mikolajewska, A.
AU - Bauer, T.
AU - Krieger, D.
AU - Pankow, W.
AU - Thiemig, D.
AU - Hauptmeier, B.
AU - Ewig, S.
AU - Wehde, D.
AU - Prediger, M.
AU - Schmager, S.
AU - Kolditz, M.
AU - Schulte-Hubbert, B.
AU - Langner, S.
AU - Albrich, W.
AU - Welte, T.
AU - Freise, J.
AU - Barten, G.
AU - Arenas Toro, O.
AU - Nawrocki, M.
AU - Naim, J.
AU - Witte, M.
AU - Kröner, W.
AU - Illig, T.
AU - Klopp, N.
AU - Kreuter, M.
AU - Herth, F.
AU - Hummler, S.
AU - Ravn, P.
AU - Vestergaard-Jensen, A.
AU - Baunbaek-Knudsen, G.
AU - Pletz, M.
AU - Kroegel, C.
AU - Frosinski, J.
AU - Winning, J.
AU - Dalhoff, K.
AU - CAPNETZ Study Group
PY - 2020
Y1 - 2020
N2 - 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.
AB - 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.
KW - bacteremia
KW - community-acquired pneumonia (CAP)
KW - fever
KW - predictor
U2 - 10.1016/j.chest.2019.10.006
DO - 10.1016/j.chest.2019.10.006
M3 - Journal article
C2 - 31669433
AN - SCOPUS:85080050032
VL - 157
SP - 529
EP - 539
JO - Chest
JF - Chest
SN - 0012-3692
IS - 3
ER -
ID: 260244124