Takayuki Komatsu1, Erika Takahashi1, Kentaro Mishima1, Takeo Toyoda2, Fumihiro Saitoh3, Akari Yasuda4, Joe Matsuoka5, Manabu Sugita1, Joel Branch6, Makoto Aoki7, Lawrence Tierney8, Kenji Inoue9. 1. Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan. 2. Department of Internal Medicine, Nerima General Hospital, Tokyo, Japan. 3. Department of General Medicine, Oizumi Health Cooperative Hospital, Tokyo, Japan. 4. Department of Nursing, Juntendo University Nerima Hospital, Tokyo, Japan. 5. Juntendo Clinical Research Support Center, Juntendo University School of Medicine, Tokyo, Japan. 6. Department of General Internal Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan. 7. Consultant to Sakura Seiki Co Ltd, Tokyo, Japan. 8. Department of Internal Medicine, University of California San Francisco, San Francisco, California. 9. of Cardiology, Juntendo University Nerima Hospital, Tokyo, Japan. Email: inouelsbm@gmail.com.
Abstract
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 the algorithm by using recursive partitioning analysis. 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.
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 the algorithm by using recursive partitioning analysis. 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.
Authors: Agustín Julián-Jiménez; Juan González Del Castillo; Eric Jorge García-Lamberechts; Itziar Huarte Sanz; Carmen Navarro Bustos; Rafael Rubio Díaz; Josep María Guardiola Tey; Ferrán Llopis-Roca; Pascual Piñera Salmerón; Mikel de Martín-Ortiz de Zarate; Jesús Álvarez-Manzanares; Julio Javier Gamazo-Del Rio; Marta Álvarez Alonso; Begoña Mora Ordoñez; Oscar Álvarez López; María Del Mar Ortega Romero; María Del Mar Sousa Reviriego; Ramón Perales Pardo; Henrique Villena García Del Real; María José Marchena González; José María Ferreras Amez; Félix González Martínez; Francisco Javier Martín-Sánchez; Pedro Beneyto Martín; Francisco Javier Candel González; Antonio Jesús Díaz-Honrubia Journal: Infection Date: 2021-09-06 Impact factor: 3.553
Authors: S Z Iqbal-Mirza; R Estévez-González; V Serrano-Romero de Ávila; E de Rafael González; E Heredero-Gálvez; A Julián-Jiménez Journal: Rev Esp Quimioter Date: 2019-11-29 Impact factor: 1.553
Authors: Taku Harada; Yukinori Harada; Kohei Morinaga; Takanobu Hirosawa; Taro Shimizu Journal: Int J Environ Res Public Health Date: 2022-02-17 Impact factor: 3.390