A study on factors that affect the febrile response in patients with nosocomial bloodstream infection
Date Issued
2009
Date
2009
Author(s)
Lu, Shu-Hua
Abstract
Background: ever is considered a hallmark sign of infection; however, some patients suffer from infection without manifesting a febrile response. Blunted febrile response can delay diagnosis and treatment and thus result in higher mortality. Most studies have focused on the influence of aging on the febrile response. Few empirical studies of febrile response have addressed non-age-related factors. Therefore this study was based on pathophysiological mechanism of febrile response and body temperature thermoregulation, and explored the factors that affect the febrile response to hospital acquired bloodstream infection.urpose: he aims of this study were to examine factors that affect febrile response including temperature at the onset, and magnitude of fever.esign: he study used a retrospective, repeated measures, comparison, correlational and predictive design.ethod: fter obtaining ethics committee approval, the investigator usedn infection control database of a university hospital in Taipei to select random sample of 600 medical records of bloodstream infection cases reported on patients hospitalized between January 1, 2007 to June 30, 2008. Research instrument was chart abstraction form designed by the author. The independent variables were white blood cell count (WBC), age, severity of co-morbidity (Charlson Comorbidity Index), physical function (Barthel Index), nutritional status (body weight, body mass index, and albumin), and microbial classification (blood culture results). To determine the factors that affect febrile response SPSS 15.0 statistical software package was used to analyze the data. The investigator used descriptive statistics to characterize the demographics and fever parameters of the sample cases. T-tests, ANOVA, Pearson correlation, multiple regression and General Estimating Equation (GEE) were used to analyze the predictive factors.esults: he cases ranged from 18 to 94 years old, 58.8% were male and 46.1% had a primary diagnosis of cancer. The top four categories of identified pathogens were staphylococcus aureus, Escherichia coli, klebsiella pneumoniae and candida spp. The mean baseline temperature was 36.33°C (SD 0.32°C). Although women had slightly higher baseline temperatures compared to men, there was no difference related to age. The mean temperature at the onset of fever was 38.33°C (SD 0.77°C); 48 cases (20.86%) had temperature at the onset lower than < 38°C. Multiple regression analysis results indicated white blood cell count, severity of co-morbidity, body weight, and microbial classification were significant predictors of temperature at the onset. However, these factors predicted only 7.4% of the variance. GEE analysis demonstrated white blood cell count, age, severity of co-morbidity, physical function and microbial classification were significant predictors of the magnitude of fever. Most cases (87.3%) had only one fever episode related to their hospital acquired bloodstream infection episode.onclusions and suggestion: he findings revealed that white blood cell count, age, severity of co-morbidity, physical function, body weight, and microbial classification have different effects on the febrile response. Febrile response is a complex biophysical adaption. For the reason many issues need to be continued investigating in the future. Especially in the relationship between white blood cell count and magnitude of fever is need to research. The findings of the study can provide clinical practitioners information to use the parameters of fever response to assess febrile patients, and can establish the base for prospective studies of the biophysical factors related to fever responses.ey words: febrile response, nosocomial bloodstream infection, temperature at the onset, magnitude of fever, chart review
Subjects
febrile response
nosocomial bloodstream infection
temperature at the onset
magnitude of fever
chart review
SDGs
File(s)![Thumbnail Image]()
Loading...
Name
ntu-98-D92426005-1.pdf
Size
23.32 KB
Format
Adobe PDF
Checksum
(MD5):090a2332fd1eb85181b61e5ee6a1296b