title: Incidence and differential characteristics of culture-negative fever following pancreas transplantation with anti-thymocyte globulin induction.
abstract: BACKGROUND
  Limited data are available on the incidence and characteristics of culture-negative fever following pancreas transplantation (PTx) with anti-thymocyte globulin (ATG) induction. Our study aims to better define the features of culture-negative fever, so it can be delineated from infectious fever, hopefully helping clinicians to guide antibiotic therapy in this high-risk patient population.
  
  
  METHODS
  We performed a retrospective cohort study of postoperative fever among 198 consecutive patients undergoing PTx at our center between August 1, 2004 and December 31, 2014. Fever was classified as culture-negative if there was neither a positive culture nor a documented clinical diagnosis of infection.
  
  
  RESULTS
  Fever was identified in 113 patients; 66 were deemed to be infectious, 39 were culture-negative, and 8 were indeterminate. High body mass index of recipient (odds ratio 1.87, 95% confidence interval: 1.15-3.03, P = 0.011) was a significant factor associated with culture-negative fever in multivariate analysis. No patients with culture-negative fever were diagnosed with infiltrates or effusion on chest radiography. In addition, an increase in white blood cell count, C-reactive protein, and serum amylase was less prominent in culture-negative fever. Culture-negative fever developed most frequently at postoperative 7 or 14 days, showing a biphasic curve.
  
  
  CONCLUSIONS
  Culture-negative fever develops in a substantial proportion of patients early after PTx. The awareness of the possibility and clinical features of post-transplant culture-negative fever might help clinicians to guide antibiotic therapy in this high-risk patient population, especially following ATG induction and early steroid withdrawal.
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: S
authors.initials: S
authors.lastname: Shin
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Y H
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: S-H
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: S-O
authors.initials: SO
authors.lastname: Lee
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: H W
authors.initials: HW
authors.lastname: Kwon
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: J Y
authors.initials: JY
authors.lastname: Choi
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. djhan@amc.seoul.kr.
authors.forename: D J
authors.initials: DJ
authors.lastname: Han
mesh_terms: D000328:Adult; D000681:Amylases / Q000097:blood; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000961:Antilymphocyte Serum / Q000008:administration & dosage / Q000627:therapeutic use*; D000071997:Blood Culture; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D005334:Fever / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects* / Q000379:methods; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015994:Incidence; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D011859:Radiography; D012189:Retrospective Studies; D028761:Withholding Treatment
chemical_list: D000900:Anti-Bacterial Agents; D000961:Antilymphocyte Serum; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D002097:C-Reactive Protein; D000681:Amylases
keywords: anti-thymocyte globulin; culture-negative fever; pancreas transplantation; steroid early withdrawal