Association between afebrile status and in-hospital mortality among adult chronic hemodialysis patients with bacteremia.

AIM: We aimed to compare the in-hospital mortality between febrile and afebrile chronic hemodialysis (HD) patients with bacteremia and analyze the blood culture positive rate according to the C-reactive protein (CRP) level.

METHODS: We collected data from 2006 to 2014. One hundred ninety bacteremic events were assigned to the "febrile group" (n = 162) and "afebrile group" (n = 28) based on the presence of fever. Fever was defined as a tympanic temperature >37.5°C or axillary temperature >37.0°C.

RESULTS: In-hospital mortality (41.4% vs. 6.1%) was higher; and the interval between admission and blood culture was longer (3 vs. 1 h) in the afebrile group than in the febrile group. The mean reason for blood culture in the afebrile group was a high CRP level.

CONCLUSIONS: An afebrile status in HD patients with bacteremia is associated with higher in-hospital mortality. Blood culture and empirical antibiotic administration, irrespective of the fever status, should be considered in HD patients with a CRP ≥ 5 mg/dL.