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.
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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