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Abstract: FR-PO819

A Higher Mortality Rate in Afebrile Bacteremia in Chronic Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Park, Keun-hoi, Seoul Asan Medical Center, Seoul, Korea (the Republic of)
  • Kim, Wonhak, Seoul Asan Medical Center, Seoul, Korea (the Republic of)
  • Kim, Soon Bae, Seoul Asan Medical Center, Seoul, Korea (the Republic of)
Background

Body temperature (BT) has received little attention as a prognostic factor in hemodialysis patients. Some previous studies reported that fever in initial bacteremia is associated with better survival. Therefore, we aimed to analyze the difference in hospital mortality between febrile and afebrile chronic hemodialysis (CHD) patients with bacteremia and investigated positive blood culture rate according to the C-reactive protein (CRP) level.

Methods

The blood culture data in CHD patients from 2006 to 2014 were collected and the bacteremic events were assigned to either “febrile group” or “afebrile group” based on the BT measured on the day of blood culture. Fever was defined as a tympanic temperature > 37.5 degrees Celsius or an axillary temperature > 37.0 degrees Celsius. Empirical antibiotics were administered immediately after blood culture. Laboratory values were considered only for the day of blood culture sampling. The primary outcome was in-hospital mortality rate, the length of ICU stay and the length of hospitalization.

Results

From a total of 1556 blood cultures, 190 bacteremias were identified excluding cases of immunosuppressive agents or anti-cancer drug use and cases of delayed blood culture. Both the febrile group (n=162) and afebrile group (n=28) showed no difference in baseline characteristics. With regard to primary outcome, in-hospital mortality rate was higher in the afebrile group (41.4% vs. 6.1%) and the interval from admission to blood culture was longer in the afebrile group (3 hours v. 1 hour). The major reason for blood culture in the afebrile group was a high CRP level. Assessing the positive blood culture rate according to the CRP level in all the 1556 cultures, we found that the rate was 5.7 % (34/600) in patients with CRP levels <5mg/dL, 15.1 % (44/292) in those with CRP levels between 5 and 10 mg/dL, and 23.8 % (158/664) in those with CRP levels >=10 mg/dL.

Conclusion

An afebrile state with bacteremia in CHD patients was associated with a higher in-hospital mortality rate. Therefore, a prompt blood culture and empirical antibiotics administration should be considered in CHD patients with high CRP levels irrespective of fever.