• Romy Schuttevaer, Anniek Brink, Jelmer Alsma, de SteenwinkelJurriaan E MJEMDepartment of Medical Microbiology and Infectious Diseases., Annelies Verbon, SchuitStephanie C ESCEDepartment of Internal Medicine, Section Acute Medicine., and Hester F Lingsma.
• Department of Internal Medicine, Section Acute Medicine.
• Eur J Emerg Med. 2021 Dec 1; 28 (6): 440447440-447.

Background And ImportancePrevious studies found that septic patients with normothermia have higher mortality than patients with fever. We hypothesize that antibiotic therapy is less frequently initiated if infectious patients present with normothermia to the emergency department (ED).ObjectivesTo examine the association of body temperature with the initiation of antibiotic therapy in patients attending the ED with suspected and proven infection. Additionally, the association of temperature with 30-day mortality was assessed.Design, Settings And ParticipantsWe conducted a retrospective cohort study between 2012 and 2016 at a tertiary university hospital. Adult patients attending the ED with a blood culture taken (i.e. suspected infection) and a positive blood culture (i.e. proven bacteremia) were included.ExposureTympanic temperature at arrival was categorized as hypothermia (<36.1°C), normothermia (36.1-38.0°C) or hyperthermia (>38.0°C).Outcome Measures And AnalysisPrimary outcome was the initiation of antibiotic therapy. A secondary outcome was 30-day mortality. Multivariable logistic regression was used to control for covariates.Main ResultsOf 5997 patients with a suspected infection, 45.8% had normothermia, 44.6% hyperthermia and 5.6% hypothermia. Patients with hyperthermia received more often antibiotic therapy (53.5%) compared to normothermic patients (27.6%, adjusted odds ratio [95% confidence interval], 2.59 [2.27-2.95]). Patients with hyperthermia had lower mortality (4.7%) than those with normothermia (7.4%, adjusted odds ratio [95% confidence interval], 0.50 [0.39-0.64]). Sensitivity analyses in patients with proven bacteremia (n = 934) showed similar results.ConclusionNormothermia in patients presenting with infection was associated with receiving less antibiotic therapy in the ED compared to presentations with hyperthermia. Moreover, normothermia was associated with a higher mortality risk than hyperthermia.Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.

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