ABSTRACT
OBJECTIVE: To determine whether the time lag between blood culture draw and the start of shaking chills is associated with blood culture positivity. METHODS: A prospective observational study was undertaken from January 2013 to March 2015 at a referral center in Okinawa, Japan. All enrolled patients were adults with an episode of shaking chills who were newly admitted to the division of infectious diseases. The study exposure was the time lag between blood culture draw and the most recent episode of shaking chills. RESULTS: Among patients whose blood cultures were obtained within 2h after shaking chills started, the blood culture positivity was 53.6% (52/97), whereas among patients whose blood cultures were obtained after more than 2h, the positivity was 37.6% (44/117) (p=0.019). The adjusted odds ratio of blood culture positivity for samples drawn within 2h after shaking chills was 1.88 (95% confidence interval 1.01-3.51, p=0.046). Escherichia coli were the most frequently detected bacteria (58/105). CONCLUSIONS: The positivity of blood cultures obtained within 2h after the start of the most recent shaking chills was higher than that for blood cultures obtained after 2h.
Subject(s)
Bacteremia/diagnosis , Blood Culture , Chills/diagnosis , Aged , Aged, 80 and over , Chills/microbiology , Citrobacter koseri/isolation & purification , Escherichia coli/isolation & purification , Female , Firmicutes/isolation & purification , Hospitalization , Humans , Japan , Klebsiella pneumoniae/isolation & purification , Male , Middle Aged , Prospective Studies , Pseudomonas aeruginosa/isolation & purification , Streptococcus/isolation & purification , Time FactorsABSTRACT
A 40-year-old woman visited our emergency room (ER) with fever and shaking chills. Blood cultures for suspicion of urinary tract infection revealed bacteremia two days later. Since <i>Streptococcus mitis</i> was detected, infective endocarditis was strongly suspected. In addition to her history of dental calculus removal, careful cardiac auscultation revealed a continuous murmur, leading to the existence of patent ductus arteriosus (PDA). PDA was confirmed by echocardiography and 3D-CT angiography. The patient was successfully treated by antibiotics and then received transcatheter PDA closure. Careful auscultation after detection of bacteremia led to a diagnosis of PDA.
ABSTRACT
PURPOSES: The difference in predictors of bacteremia between elderly and non-elderly patients is unclear despite the aging of society. The objective was to determine predictors of bacteremia among elderly patients aged 80 years and older compared to non-elderly patients aged 18 to 79 years. METHODS: A referral hospital-based retrospective descriptive study from April 2012 to March 2013 in Okinawa, Japan. All enrolled patients were adults suspected of having bacterial infection who had been newly admitted into the Division of Infectious Diseases. HIV- infected patients were excluded. Exposures were a history of shaking chills, prior antibiotics use within 48 hours, vital signs, and laboratory inflammation markers on admission. Outcome was blood culture positivity. RESULTS: Three hundred and sixty-six patients were enrolled. Median age was 78.5 (interquartile range [IQR]: 62-88). Among patients aged 18 to 79 years, shaking chills (adjusted odds ratio [AOR] 2.22, 95% confidence interval [CI]: 1.09-4.51) and previous antibiotics use (AOR 0.08, 95% CI: 0.01-0.68) were significant. However, among patients aged 80 years and older, shaking chills (AOR 3.06, 95% CI: 1.30-7.19) and body temperature above 38.5°C (AOR 2.98, 95% CI: 1.30-6.83) were significant. CONCLUSIONS: A history of shaking chills and vital signs indicating high body temperature were two findings that were useful in predicting bacteremia, especially in elderly patients aged 80 years and older. Further study is needed to assess whether the result is applicable in other regions and populations.
