Fever, abnormal white blood cell count, neutrophilia, and elevated serum c-reactive protein in adult hospitalized patients with bacteremia

Southern Medical Journal, 09/20/2012

Absence of fever, normal white blood cell count (WBC), and lack of neutrophilia are common in patients with bacteremia and may be confounded by a variety of factors; however, serum C–reactive protein (CRP) remains elevated in the majority (>98%) of bacteremic episodes.

Methods

  • Frequencies of fever (temperature ≥100°F), abnormal WBC count (≥10,000/μL or <4500/ μL), neutrophilia (neutrophils ≥80%) and potential factors that may be associated with negative results, and frequency of elevated serum CRP were studied retrospectively in 622 bacteremic episodes in adult patients at a community teaching hospital.

Results

  • The frequencies of individual parameters were as follows: fever, 78.4% (95% confidence interval [CI] 74.9%–81.6%); abnormal WBC count, 65.2% (95% CI 61.3%–69.0%); neutrophilia, 67.5% (95% CI 63.7%–71.2%); and elevated CRP (>0.8 mg/dL), 98.4% (95% CI 97%–99.2%).
  • Age 50 years and older, corticosteroid use, and isolation of either Staphylococcus sp not aureus or Enterococcus sp combined were independently associated with the absence of fever (P ≤ 0.01 for all).
  • Isolation of Staphylococcus sp not aureus/Enterococcus and lack of corticosteroid use were independently associated with normal WBC (P < 0.05 for both).
  • Nonwhite race and primary bacteremia were independently associated with lack of neutrophilia (P < 0.05 for both).

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