Predicting bacteremia using food comsumption and shaking chill

2018 Fiscal Year Final Research Report

• Project/Area Number: 15K19294
• Research Category: Grant-in-Aid for Young Scientists (B)
• Allocation Type: Multi-year Fund
• Research Field: General internal medicine(including psychosomatic medicine)
• Research Institution: Juntendo University
• Principal Investigator: Komatsu Takayuki 順天堂大学, 医学部, 助教 (70621928)
• Research Collaborator: SUGITA manabu ; INOUE kenji ; TAKAHASHI erika ; MISHIMA kentaro ; TOYODA takeo ; SAITOH fumihiro ; AOKI makoto ; YASUDA akari
• Project Period (FY): 2015-04-01 – 2019-03-31
• Keywords: 菌血症 / 食事摂取量 / 悪寒戦慄 / 診断予測

Outline of Final Research Achievements

The hospitalized patients who were underwent blood cultures between April 2013 and August 2014 were enrolled. The patients with anorexia-inducing conditions such as gastrointestinal disease, with receiving chemotherapy, or with contaminated BCs were excluded. In 1847 patients, we assessed the patients’oral food intake based on the meal immediately prior to the blood culture. We also concurrently evaluated for a history of shaking chills. The presence of poor food consumption, defined as oral food intake < 80%, had a sensitivity of 93.7% (95% confidence interval [CI],89.4%-97.9%) for true bacteremia, and the absence of poor food consumption, defined as oral food intake >80%, had a negative likelihood ratio (LR) of 0.18 (95% CI, 0.17-0.19) for excluding true bacteremia, respectively. Conversely, the presence of the shaking chills had a specificity of 95.1% (95% CI, 90.7%-99.4%) and a positive LR of 4.78 (95% CI, 4.56-5.00) for true bacteremia.

Free Research Field

救急医学

Academic Significance and Societal Importance of the Research Achievements

本研究の最大の特徴は、重篤な感染症の病態である菌血症の有無を検査をすることなく、自身で確認できる「食事摂取量」や「寒気」により予測できることを証明した点である。特に「食事が摂れていれば元気である」という社会通念を学術的に証明したことは意義深いと考える。なお本研究は看護師観察により確認したが、もともと自覚症状としての項目でもあり、次点は患者自身での確認でも同等の効果を得ることを目標としているが、本研究テーマは医療経済学的にも抗菌薬適正使用による薬剤耐性菌対策の観点においても、適切な感染症診療を医療従事者だけでなく国民全員で取り組むことが可能であることを示唆している。