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Updated: Aug 4, 2025
Esophageal Heat Transfer for Patient Temperature Control and Targeted Temperature Management
Published on: November 21, 2017
Relationship Between Oral Temperature and Bacteremia in Hospitalized Patients
Sidra L Speaker1, Elizabeth R Pfoh2, Matthew A Pappas2
1Department of Emergency Medicine, University of California San Diego, San Diego, CA, USA.
Background:
Early recognition and treatment of bacteremia can be lifesaving. Fever is a well-known marker of bacteremia, but the predictive value of temperature has not been fully explored.
Objective:
To describe temperature as a predictor of bacteremia and other infections.
Design:
Retrospective review of electronic health record data.
Setting:
A single healthcare system comprising 13 hospitals in the United States.
Patients:
Adult medical patients admitted in 2017 or 2018 without malignancy or immunosuppression.
Main Measures:
Maximum temperature, bacteremia, influenza and skin and soft tissue (SSTI) infections based on blood cultures and ICD-10 coding.
Key Results:
Of 97,174 patients, 1,518 (1.6%) had bacteremia, 1,392 (1.4%) had influenza, and 3,280 (3.3%) had an SSTI. There was no identifiable temperature threshold that provided adequate sensitivity and specificity for bacteremia. Only 45% of patients with bacteremia had a maximum temperature ≥ 100.4˚F (38˚C). Temperature showed a U-shaped relationship with bacteremia with highest risk above 103˚F (39.4˚C). Positive likelihood ratios for influenza and SSTI also increased with temperature but showed a threshold effect at ≥ 101.0 ˚F (38.3˚C). The effect of temperature was similar but blunted for patients aged ≥ 65 years, who frequently lacked fever despite bacteremia.
Conclusions:
The majority of bacteremic patients had maximum temperatures below 100.4 ˚F (38.0˚C) and positive likelihood ratios for bacteremia increased with high temperatures above the traditional definition of fever. Efforts to predict bacteremia should incorporate temperature as a continuous variable.
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