2312. Value of Leukocytosis and Fever for Presence of Bacteremia in Adult Solid Organ Transplantation.
Session: Poster Abstract Session: Transplants: Infection Epidemiology and Outcome in Solid Organ Transplantation
Saturday, October 29, 2016
Room: Poster Hall
Background: Bacteremia is a major cause of morbidity and mortality for recipients of solid organ transplants (SOT). Fever and leukocytosis are early harbingers of bacteremia in non-SOT patients but their sensitivity to detect bacteremia in SOT recipients is unclear given the suppressive effects of immunosuppression. Our study describes the incidence of fever and leukocytosis in SOT recipients within 48 hours of documented bacteremia.

Methods: This is a retrospective, observational cohort study of consecutive patients admitted to an academic tertiary care hospital from January 2014 to December 2015. Body temperature and White Blood Cell (WBC) counts 48 hours before collection of positive blood culture were reviewed. Fever was defined as temperature greater than 100.4 F and leukocytosis was defined as WBCs greater than 10,000 cells per microliter. Blood cultures consistent with contamination were excluded.

Results: Thirty-six SOT recipients were included in our analysis with amedian age was 59 (IQR 49,67). The most common organs transplanted were kidney (n = 26, 72%) and liver (n = 6, 17%). Forty-seven percent were within two years of SOT. Nineteen percent had hospital-onset bacteremia. Two third had gram-negative bacteremia. The most common primary source of bacteremia was urine (22.6%). Only 14 (38.9%) had leukocytosis and 16 (44.4%) had fever within 48 hours of documented bacteremia. There was no significant correlation between fever and leukocytosis (r = -0.14, p = 0.4) with only 5 patients demonstrating both. Most patients were started on empiric antibiotics (32, 89%), but in 7 (19%), the organism was not sensitive to empiric therapy

Conclusion: In SOT recipients with true bacteremia, less than half had fever or leukocytosis within 48 hours of documented bacteremia. Although these signs are common early markers of bacteremia in the general population, they may not be sensitive clinical indicators in SOT recipients. Further research is warranted to develop more sensitive biomarkers for bacteremia in this at-risk population.

Ana Aldea, DO1, Tiffany Bias, PharmD, BCPS, AAHIVP2, Nancy Law, DO1, Suzanne Boyle, MD3, Gregory Malat, PharmD, BCPS4, Sindhura Talluri, MD3, Meera Harhay, MD3, Karthik Ranganna, MD3, Alden Doyle, MD, MPH3 and Dong Heun Lee, MD1, (1)Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA, (2)Pharmacy, Hahnemann University Hospital, Philadelphia, PA, (3)Division of Nephrology, Drexel University College of Medicine, Philadelphia, PA, (4)Surgery, Hahnemann University Hospital, Philadelphia, PA

Disclosures:

A. Aldea, None

T. Bias, None

N. Law, None

S. Boyle, None

G. Malat, None

S. Talluri, None

M. Harhay, NIH: Grant Investigator and K23DK105207 , Grant recipient

K. Ranganna, None

A. Doyle, None

D. H. Lee, None

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