Fever, Abnormal White Blood Cell Count, Neutrophilia, and Elevated Serum C-Reactive Protein in Adult Hospitalized Patients with Bacteremia

OBJECTIVES: Relatively little is known about the prevalence of and factors associated with the absence of fever, normal white blood cell count (WBC), lack of neutrophilia, and the frequency of elevated serum C-reactive protein (CRP) in adult hospitalized patients with bacteremia. 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). CONCLUSIONS: Absence of fever, normal WBC, and lack of neutrophilia are common in patients with bacteremia and may be confounded by a variety of factors; however, serum CRP remains elevated in the majority (>98%) of bacteremic episodes.