title: Chills During Hemodialysis: Prediction and Prevalence of Bacterial Infections - A Retrospective Cohort Study.
abstract: BACKGROUND
  Chills are a complication of patients undergoing hemodialysis. The rate of infection among hemodialysis patients presenting with chills is not well established, and empirical broad-spectrum antibiotics are usually the rule.
  
  
  METHODS
  We performed a retrospective study aiming to assess the rates of infection and bacteremia in hemodialysis patients presenting with chills. We evaluated risk factors for infection and bacteremia and tested a prediction model for infection.
  
  
  RESULTS
  Overall, 269 hemodialysis patients with a first episode of chills were included. Ninety patients (33.5%) had bacteremia and 162 (60.2%) had an infection. Risk factors for bacteremia in multivariate analysis included fever (odds ratio [OR] 1.6; 95% confidence interval [CI], 1.1-2.3; P = .009) and vascular catheter as dialysis access (OR 6.2; 95% CI, 3.2-12.0, P <.001). Leukocytosis was an additional risk factor in multivariate analysis for any type of infection (OR 1.265; 95% CI, 1.113-1.438; P <.001). Using a prediction model to evaluate patients without obvious source of infection, we found that patients with fistula or graft as their access, without fever, abnormal leukocytes, or hypoalbuminemia, had a low rate (1/17, 6%) of bacteremia.
  
  
  CONCLUSIONS
  Hemodialysis patients presenting with chills during dialysis, with or without fever, have high rates (∼60%) of infection. Patients with no obvious source of infection, with fistula or graft as access, presenting without fever, leukocytosis, or hypoalbuminemia have low risk for bacteremia and may be investigated without prompt antibiotic treatment. All other patients should receive antibiotic coverage immediately following a chills episode.
authors.affiliation: Medicine A, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Daniel
authors.initials: D
authors.lastname: Shepshelovich
authors.affiliation: Medicine A, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Dana
authors.initials: D
authors.lastname: Yelin
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Lior Or
authors.initials: LO
authors.lastname: Bach
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Noy
authors.initials: N
authors.lastname: Halevy
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Yonatan
authors.initials: Y
authors.lastname: Ziv
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel; Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
authors.forename: Hefziba
authors.initials: H
authors.lastname: Green
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel; Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
authors.forename: Benaya
authors.initials: B
authors.lastname: Rozen-Zvi
authors.affiliation: Laboratory of Clinical Microbiology, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
authors.forename: Haim
authors.initials: H
authors.lastname: Ben-Zvi
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel; Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
authors.forename: Jihad
authors.initials: J
authors.lastname: Bishara
authors.affiliation: Medicine A, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Anat
authors.initials: A
authors.lastname: Gafter-Gvili
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel; Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel. Electronic address: dafna.yahav@gmail.com.
authors.forename: Dafna
authors.initials: D
authors.lastname: Yahav
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology*; D023341:Chills / Q000209:etiology* / Q000382:microbiology; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D015233:Models, Statistical; D015995:Prevalence; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Bacteremia; Chills; Dialysis; Infections