Early detection of bacteremia is cl...

Early detection of bacteremia is clinically important for facilitating rapid intervention before sepsis exhibits Jaimes and colleagues report forward a prospective study of clinical predictors for bacteremia in hospitalized patients.

This reflection was conducted at an academic hospital center using 517 inpatients who had laboratory entreatys for blood cultures. Exclusion criteria included incomplete clinical information, death or hospital discharge within 24 hours, organ transplant within the past year, and pregnancy, all of which remov 17 patients from the contemplation An extensive list of clinical variables was tracked to deter-mine if any association with positive offspring cultures could be established. The variables included age, human immunodeficiency virus (HIV) infection, chronic renal failure, diabetes, chemotherapy, systemic steroid use, cancer diagnosis, temperature elevation, chills, heart rate, kin pressure, leukocyte count, trauma or surgery appearance of a central venous catheter, mechanical ventilation, detail of hospital stay, and use of antibiotics. A positive vital fluid culture was defined as united or more cultures for any recognized pathogen or couple or more cultures of a belonging to all skin organism, if there also was evidence of a systemic inflammatory response

More than single in kind half of the inpatients followed in the cogitation had none of the clinical variables. The chiefly commonly identified variables were trauma or surgery central venous catheter use, chronic renal failure, and diabetes. HIV seropositivity was ready in 6.6 percent of patients.

Positive vital current cultures, which occurred in 178 percent of patients, were associated with a more than 50 percent increase in the mortality rate compared with the overall consideration cohort. Multivariate analysis identified the statistically significant predictors of bacteremia as age 30 years or older; heart rate 90 beats for minute or higher; temperature 378[degrees]C (100[degrees]F) or higher; leukocyte consider 12,000 cells per mL (12 x [10sup6] through L) or higher; presence of a central venous catheter; and longitudinal dimensions of hospital stay 10 days or longer Each of these predictors approximately doubled the risk of a positive life-blood culture. Excluding blood cultures positive for possible skin flora contaminants (i.e., coagulase-negative Staphylococcus) did not change the be the effects significantly.

The authors judge that several readily identifiable bedside clinical variables are significant predictors of bacteremia.

Jaimes F et al. Predicting bacteremia at the bedside. Clin Infect Dis February 1 2004;38:357-62

COPYRIGHT 2004 American Academy of Family Physicians

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