A simple algorithm for predicting bacteremia using food consumption and shaking chills: a prospective observational study
BACKGROUND
Predicting the presence of true bacteremia based on clinical examination is unreliable.
OBJECTIVE
We aimed to construct a simple algorithm for predicting true bacteremia by using food consumption and shaking chills.
DESIGN
A prospective multicenter observational study.
SETTING
Three hospital centers in a large Japanese city.
PARTICIPANTS
In total, 1,943 hospitalized patients aged 14 to 96 years who underwent blood culture acquisitions between April 2013 and August 2014 were enrolled. Patients with anorexia-inducing conditions were excluded.
INTERVENTIONS
We assessed the patients’ oral food intake based on the meal immediately prior to the blood culture with definition as “normal food consumption” when >80% of a meal was consumed and “poor food consumption” when <80% was consumed. We also concurrently evaluated for a history of shaking chills.
MEASUREMENTS
We calculated the statistical characteristics of food consumption and shaking chills for the presence of true bacteremia, and subsequently built
RESULTS
Among 1,943 patients, 223 cases were true bacteremia. Among patients with normal food consumption, without shaking chills, the incidence of true bacteremia was 2.4% (13/552). Among patients with poor food consumption and shaking chills, the incidence of true bacteremia was 47.7% (51/107). The presence of poor food consumption had a sensitivity of 93.7% (95% confidence interval [CI], 89.4%-97.9%) for true bacteremia, and the absence of poor food consumption (ie, normal food consumption) had a negative likelihood ratio (LR) of 0.18 (95% CI, 0.17-0.19) for excluding true bacteremia, respectively. Conversely, the presence of the shaking chills had a specificity of 95.1% (95% CI, 90.7%-99.4%) and a positive LR of 4.78 (95% CI, 4.56-5.00) for true bacteremia.
CONCLUSION
A 2-item screening checklist for food consumption and shaking chills had excellent statistical properties as a brief screening instrument for predicting true bacteremia. Journal of Hospital Medicine 2017;12:510-515. © 2017 Society of Hospital Medicine
© 2017 Society of Hospital Medicine
CONCLUSION
In conclusion, we have established a simple algorithm to identify patients with suspected true bacteremia who require the acquisition of blood cultures. This extremely simple model can enable physicians to make a rapid bedside estimation of the risk of true bacteremia.
Acknowledgment
The authors thank Drs. H. Honda and S. Saint, and Ms. A. Okada for their helpful discussions with regard to this study; Ms. M. Takigawa for the collection of data; and Ms. T. Oguri for providing infectious disease consultation on the pathogenicity of the identified organisms.
Disclosure
This work was supported by JSPS KAKENHI Grant Number 15K19294 (to TK) and 20590840 (to KI) from the Japan Society for the Promotion of Science. The authors report no potential conflicts of interest relevant to this article.
