Are corticosteroids or end-stage renal failure associated with an afebrile presentation of Gram-negative bacteraemia?

Autor: Even Dar R; Internal Medicine B, Rambam Health Care Campus, Haifa, Israel. Electronic address: razieven@gmail.com., Kurnik D; The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel; Clinical Pharmacology Unit, Rambam Health Care Campus, Haifa, Israel., Bishop B; Nephrology Department, Rambam Health Care Campus, Haifa, Israel., Bogner I; Nephrology Department, Rambam Health Care Campus, Haifa, Israel., Azzam Z; Internal Medicine B, Rambam Health Care Campus, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel., Paul M; The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel; Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel., Neuberger A; Internal Medicine B, Rambam Health Care Campus, Haifa, Israel; Nephrology Department, Rambam Health Care Campus, Haifa, Israel; Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel.
Jazyk: angličtina
Zdroj: International journal of antimicrobial agents [Int J Antimicrob Agents] 2020 Sep; Vol. 56 (3), pp. 106070. Date of Electronic Publication: 2020 Jun 28.
DOI: 10.1016/j.ijantimicag.2020.106070
Abstrakt: Objectives: Assertions regarding afebrile presentation of sepsis frequently lead to superfluous antibiotic treatment. This study aimed to identify the risk factors for afebrile presentation of bacteraemia, focusing on glucocorticoid (GC) treatment and end-stage renal disease (ESRD).
Methods: This retrospective cohort study included all patients with bacteraemia caused by common Gram-negative bacteria in one hospital. The exposure variables were GC treatment, administered for at least 48 hours before bacteraemia onset, and ESRD, defined as patients undergoing dialysis. Risk factors were assessed for afebrile presentation, defined as temperature between 36.0-37.7°C for all measurements, 48 hours prior to blood culture collection. Analyses were subgrouped by community-onset and hospital-acquired Gram-negative bacteraemia (GNB). Propensity score (PS)-weighted multivariate analyses were conducted.
Results: Of 4179 patients with GNB, 1090 (26.1%) presented without fever before blood culture collection. In community-onset GNB, GC treatment was significantly associated with afebrile presentation, PS-weighted OR 1.42 (95% CI 1.25-1.61), absolute risk increase 7% (95% CI 4.3-9.8%), while ESRD was not. For hospital-acquired GNB, ESRD was significantly associated with afebrile presentation (OR 1.53; 95% CI 1.25-1.86; absolute risk increase 8.5%; 95% CI 4.4-13.1%); GC was not. Other risk factors for afebrile presentation in both subgroups included increasing Charlson comorbidity score, bacteraemia with non-fermenters Pseudomonas aeruginosa or Stenotrophomonas maltophilia (compared with Enterobacteriaceae), and lower albumin levels. Aging was not associated with afebrile presentation of GNB.
Conclusion: Although significant associations between GC and ESRD and afebrile presentation of GNB were observed, they were different in community-onset and hospital-acquired GNBs, and absolute risk increases were small.
(Copyright © 2020 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.)
Databáze: MEDLINE
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