BACKGROUND Fever is a common symptom when patients present to Emergency Departments. It is unclear if the febrile response of bacteremic hemodialysis-dependent patients differs from bacteremic patients not receiving hemodialysis. The objective of this study was to compare Emergency Departments triage temperatures of patients with and without hemodialysis-dependent end-stage rental disease who have Staphylococcus aureus bacteremia and determine the incidence of afebrile S. aureus bacteremia. METHODS Paired, retrospective cohort study of 37 patients with and 37 patients without hemodialysis hospitalized with Methicillin-resistant or Methicillin-susceptible S. aureus bacteremia. Emergency Department triage temperatures were reviewed for all patients, as were potential confounding variables. RESULTS 54% (95% CI, 38-70%) and 82% (95% CI 65-91%) of hemodialysis and non-hemodialysis patients did not have a detectable fever (<100.4 °F) at triage. Triage temperatures were 100.5 °F (95% CI 99.9-101.2 °F) and 99.0 °F (95% CI 98.4-99.6 °F) in the hemodialysis and non-hemodialysis cohorts, respectively (p < 0.001). Triage temperature in patients with and without diabetes mellitus was 99.2 °F (95% CI 98.4-99.9 °F) and 100.4 °F (95% CI 99.7-101.0 °F), respectively (p = 0.03). We were unable to detect a significant effect of diabetes mellitus and other potential confounding variables on differences in temperature between the hemodialysis and non-hemodialysis cohorts (all interactions p > 0.19). CONCLUSIONS Hemodialysis-dependent patients with S. aureus bacteremia had significantly higher temperatures than non- hemodialysis-dependent end stage renal disease patients but more than half of patients were without detectable fever at triage, possibly reflecting use of insensitive methods for measuring temperature. Absence of fever at presentation to the Emergency Department should not delay blood culture acquisition in patients who are at increased risk of S. aureus bacteremia.

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终末期肾病的细菌血症患者在急诊就诊时会发烧吗？一项配对回顾性队列研究。

背景技术当患者到急诊科就诊时，发烧是一种常见症状。尚不清楚依赖细菌性血液透析的患者的发热反应是否不同于未接受血液透析的细菌性患者。这项研究的目的是比较急诊科对患有和不患有依赖血液透析的金黄色葡萄球菌菌血症的终末期租赁病患者的分诊温度，并确定发热的金黄色葡萄球菌菌血症的发生率。方法对37例接受耐甲氧西林或易感甲氧西林的金黄色葡萄球菌菌血症的37例血液透析患者和37例未进行血液透析的患者进行回顾性队列研究。审查了所有患者的急诊分诊温度，以及潜在的混杂变量。结果54％（95％CI，38-70％）和82％（95％CI 65-91％）的血液透析和非血液透析患者在分诊时均未发现发烧（<100.4°F）。血液透析和非血液透析人群的分类温度分别为100.5°F（95％CI 99.9-101.2°F）和99.0°F（95％CI 98.4-99.6°F）（p <0.001）。有和没有糖尿病的患者的分诊温度分别为99.2°F（95％CI 98.4-99.9°F）和100.4°F（95％CI 99.7-101.0°F）（p = 0.03）。我们无法检测到糖尿病和其他潜在混杂变量对血液透析和非血液透析人群之间的温度差异的显着影响（所有相互作用p> 0.19）。结论血液透析依赖的S. 与非依赖血液透析的终末期肾病患者相比，金黄色菌菌血症的温度明显更高，但超过一半的患者在分诊时没有可检测到的发烧，这可能反映了使用不敏感的温度测量方法。向金黄色葡萄球菌菌血症风险增加的患者，在急诊科就诊时不发烧不应延迟其血液培养。