{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T20:10:09Z","timestamp":1752005409733,"version":"3.41.2"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T00:00:00Z","timestamp":1751932800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"JSPS KAKENHI","award":["JP19K16990 and JP23K10725"],"award-info":[{"award-number":["JP19K16990 and JP23K10725"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Bacteremia, a critical condition that can lead to sepsis, is often diagnosed using blood cultures, which may yield false positives, leading to unnecessary treatments. Although clinical indicators, such as shaking chills and food consumption, have been identified as predictors of bacteremia, their diagnostic accuracy in outpatients, particularly when considering the timing of blood collection, remains unclear. This study aimed to assess the diagnostic accuracy of self-reported food consumption and shaking chills in detecting bacteremia, focusing on the time interval between the last meal and blood culture collection. This prospective, multicenter, observational study included outpatients aged\u2009&gt;\u200916 years who could eat orally and underwent blood cultures in the emergency or general medicine department from April 2019 to March 2021. Food consumption before blood culture was self-reported using a medical questionnaire and categorized as \u201cnormal\u201d (\u226580%) or \u201cpoor\u201d (&lt;80%). The presence of chills was also assessed. Among 534 patients (mean age 68.3\u2009\u00b1\u200921.9 years, 51.3% men), 68 had bacteremia. The absence of poor food consumption (i.e., normal food consumption) had a negative predictive value of 91.2% (95% confidence interval, 88.8\u201393.6) and a negative likelihood ratio of 0.66 (0.23\u20131.94). Excluding the blood cultures collected between 10 pm and 8 am, these values increased to 96.2% (94.5\u201397.8) and 0.32 (0.12\u20130.89), respectively. Shaking chills had a positive likelihood ratio of 3.74 (2.75\u20134.73), increasing to 4.21 (3.22\u20135.19) after the same exclusion. Self-reported shaking chills were good positive predictors of bacteremia in outpatients, whereas self-reported normal food consumption, when accounting for the time between meals, ruled out bacteremia. These findings could help improve the early diagnosis and management of bacteremia, particularly in outpatient settings, and may contribute to the development of self-report tools for clinical decision-making.<\/jats:p>","DOI":"10.1371\/journal.pone.0327789","type":"journal-article","created":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T19:32:23Z","timestamp":1752003143000},"page":"e0327789","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic accuracy of self-reported food consumption and shaking chills in predicting bacteremia in outpatients: A prospective, multicenter observational study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8730-2081","authenticated-orcid":true,"given":"Takayuki","family":"Komatsu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenji","family":"Inoue","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuki","family":"Someya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Hirano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fumihiro","family":"Saitoh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Makoto","family":"Aoki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2120-5561","authenticated-orcid":true,"given":"Akihiro","family":"Inui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lawrence M.","family":"Tierney Jr","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kentaro","family":"Mishima","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keiko","family":"Mizuno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroki","family":"Takami","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomohisa","family":"Nomura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manabu","family":"Sugita","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,7,8]]},"reference":[{"issue":"5","key":"pone.0327789.ref001","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1001\/jama.2012.8262","article-title":"Does this adult patient with suspected bacteremia require blood cultures?","volume":"308","author":"B Coburn","year":"2012","journal-title":"JAMA"},{"issue":"8","key":"pone.0327789.ref002","doi-asserted-by":"crossref","first-page":"3655","DOI":"10.1128\/JCM.41.8.3655-3660.2003","article-title":"Epidemiology and outcome of nosocomial and community-onset bloodstream infection","volume":"41","author":"DJ Diekema","year":"2003","journal-title":"J Clin Microbiol"},{"issue":"4","key":"pone.0327789.ref003","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1128\/CMR.00002-14","article-title":"Population-based epidemiology and microbiology of community-onset bloodstream infections","volume":"27","author":"KB Laupland","year":"2014","journal-title":"Clin Microbiol Rev"},{"issue":"8","key":"pone.0327789.ref004","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1001\/archinte.167.8.834","article-title":"Age- and sex-associated trends in bloodstream infection: a population-based study in Olmsted county, Minnesota","volume":"167","author":"DZ Uslan","year":"2007","journal-title":"Arch Intern Med"},{"issue":"1","key":"pone.0327789.ref005","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1093\/oxfordjournals.aje.a114206","article-title":"Bacteremia in Charleston county, South Carolina","volume":"123","author":"GA Filice","year":"1986","journal-title":"Am J Epidemiol"},{"issue":"1","key":"pone.0327789.ref006","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1093\/cid\/ciq069","article-title":"Temporal changes in the incidence and 30-day mortality associated with bacteremia in hospitalized patients from 1992 through 2006: a population-based cohort study","volume":"52","author":"M S\u00f8gaard","year":"2011","journal-title":"Clin Infect Dis"},{"issue":"6","key":"pone.0327789.ref007","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1017\/S0950268806007631","article-title":"Burden of community-onset bloodstream infection: a population-based assessment","volume":"135","author":"KB Laupland","year":"2007","journal-title":"Epidemiol Infect"},{"issue":"1","key":"pone.0327789.ref008","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1017\/S0950268812000428","article-title":"Population-based laboratory assessment of the burden of community-onset bloodstream infection in Victoria, Canada","volume":"141","author":"KB Laupland","year":"2013","journal-title":"Epidemiol Infect"},{"issue":"11","key":"pone.0327789.ref009","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1007\/s00134-021-06506-y","article-title":"Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021","volume":"47","author":"L Evans","year":"2021","journal-title":"Intensive Care Med"},{"key":"pone.0327789.ref010","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/1471-2334-14-13","article-title":"A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance","volume":"14","author":"BG Bell","year":"2014","journal-title":"BMC Infect Dis"},{"key":"pone.0327789.ref011","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.c2096","article-title":"Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis","volume":"340","author":"C Costelloe","year":"2010","journal-title":"BMJ"},{"issue":"7","key":"pone.0327789.ref012","doi-asserted-by":"crossref","first-page":"510","DOI":"10.12788\/jhm.2764","article-title":"A Simple algorithm for predicting bacteremia using food consumption and shaking chills: a prospective observational study","volume":"12","author":"T Komatsu","year":"2017","journal-title":"J Hosp Med"},{"issue":"11","key":"pone.0327789.ref013","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1093\/qjmed\/hci120","article-title":"A simple prediction algorithm for bacteraemia in patients with acute febrile illness","volume":"98","author":"Y Tokuda","year":"2005","journal-title":"QJM: An Int J Med"},{"issue":"12","key":"pone.0327789.ref014","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1016\/j.amjmed.2005.06.043","article-title":"The degree of chills for risk of bacteremia in acute febrile illness","volume":"118","author":"Y Tokuda","year":"2005","journal-title":"Am J Med"},{"issue":"7","key":"pone.0327789.ref015","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1093\/qjmed\/89.7.515","article-title":"The systemic inflammatory response syndrome as a predictor of bacteraemia and outcome from sepsis","volume":"89","author":"GR Jones","year":"1996","journal-title":"QJM"},{"issue":"9","key":"pone.0327789.ref016","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1002\/jhm.1978","article-title":"Predicting bacteremia based on nurse-assessed food consumption at the time of blood culture","volume":"7","author":"T Komatsu","year":"2012","journal-title":"J Hosp Med"},{"key":"pone.0327789.ref017","article-title":"STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies","volume":"351","author":"PM Bossuyt","year":"2015","journal-title":"BMJ"},{"issue":"4","key":"pone.0327789.ref018","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1093\/clind\/24.4.584","article-title":"The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults","volume":"24","author":"MP Weinstein","year":"1997","journal-title":"Clin Infect Dis"},{"issue":"4","key":"pone.0327789.ref019","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1128\/CMR.00062-05","article-title":"Updated review of blood culture contamination","volume":"19","author":"KK Hall","year":"2006","journal-title":"Clin Microbiol Rev"},{"issue":"7","key":"pone.0327789.ref020","doi-asserted-by":"crossref","first-page":"2437","DOI":"10.1128\/JCM.40.7.2437-2444.2002","article-title":"Minimizing the workup of blood culture contaminants: implementation and evaluation of a laboratory-based algorithm","volume":"40","author":"SS Richter","year":"2002","journal-title":"J Clin Microbiol"},{"issue":"9","key":"pone.0327789.ref021","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0222545","article-title":"Strategies for increasing diagnostic yield of community-onset bacteraemia within the emergency department: a retrospective study","volume":"14","author":"K Rothe","year":"2019","journal-title":"PLoS One"},{"issue":"1","key":"pone.0327789.ref022","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1001\/archinte.1972.03650010072013","article-title":"Evaluation of positive blood cultures. Guidelines for early differentiation of contaminated from valid positive cultures","volume":"130","author":"RR MacGregor","year":"1972","journal-title":"Arch Intern Med"},{"issue":"6","key":"pone.0327789.ref023","doi-asserted-by":"crossref","first-page":"1644","DOI":"10.1378\/chest.101.6.1644","article-title":"Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP\/SCCM consensus conference committee. American college of chest physicians\/society of critical care medicine","volume":"101","author":"RC Bone","year":"1992","journal-title":"Chest"},{"issue":"8","key":"pone.0327789.ref024","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The third international consensus definitions for sepsis and septic shock (Sepsis-3)","volume":"315","author":"M Singer","year":"2016","journal-title":"JAMA"},{"issue":"6","key":"pone.0327789.ref025","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1016\/j.jmii.2011.04.006","article-title":"Predictive model for bacteremia in adult patients with blood cultures performed at the emergency department: a preliminary report","volume":"44","author":"C-P Su","year":"2011","journal-title":"J Microbiol Immunol Infect"},{"issue":"5","key":"pone.0327789.ref026","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-044270","article-title":"Diagnostic performance of food consumption for bacteraemia in patients admitted with suspected infection: a prospective cohort study","volume":"11","author":"T Takada","year":"2021","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0327789.ref027","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1186\/s12916-024-03467-z","article-title":"Utility of shaking chills as a diagnostic sign for bacteremia in adults: a systematic review and meta-analysis","volume":"22","author":"T Aita","year":"2024","journal-title":"BMC Med"},{"key":"pone.0327789.ref028","doi-asserted-by":"crossref","DOI":"10.1017\/S0950268820000746","article-title":"Risk of bacteremia in patients presenting with shaking chills and vomiting - a prospective cohort study","volume":"148","author":"M Holmqvist","year":"2020","journal-title":"Epidemiol Infect"},{"issue":"1","key":"pone.0327789.ref029","doi-asserted-by":"crossref","first-page":"11121","DOI":"10.1038\/s41598-022-15408-y","article-title":"Diagnostic accuracy of quick SOFA score and inflammatory biomarkers for predicting community-onset bacteremia","volume":"12","author":"T Matono","year":"2022","journal-title":"Sci Rep"},{"issue":"4","key":"pone.0327789.ref030","first-page":"364","article-title":"qSOFA does not predict bacteremia in patients with severe manifestations of sepsis","volume":"7","author":"MP Cheng","year":"2022","journal-title":"J Assoc Med Microbiol Infect Dis Can"},{"issue":"4","key":"pone.0327789.ref031","doi-asserted-by":"crossref","DOI":"10.1016\/j.jemermed.2023.12.005","article-title":"Evaluating clinical prediction rules for bacteremia detection in the emergency department: a retrospective review","volume":"66","author":"L McNab","year":"2024","journal-title":"J Emerg Med"},{"issue":"1","key":"pone.0327789.ref032","doi-asserted-by":"crossref","first-page":"57","DOI":"10.3390\/jpm14010057","article-title":"A simple bacteremia score for predicting bacteremia in patients with suspected infection in the emergency department: a cohort study","volume":"14","author":"H Han","year":"2023","journal-title":"J Pers Med"},{"issue":"11","key":"pone.0327789.ref033","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-052582","article-title":"Prehospital delay is an important risk factor for mortality in community-acquired bloodstream infection (CA-BSI): a matched case-control study","volume":"11","author":"M Holmbom","year":"2021","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0327789.ref034","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1186\/s12879-019-4721-9","article-title":"Antimicrobial resistance of bacteraemia in the emergency department of a German university hospital (2013-2018): potential carbapenem-sparing empiric treatment options in light of the new EUCAST recommendations","volume":"19","author":"K Rothe","year":"2019","journal-title":"BMC Infect Dis"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0327789","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T19:32:31Z","timestamp":1752003151000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0327789"}},"subtitle":[],"editor":[{"given":"Adriana","family":"Calderaro","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,7,8]]},"references-count":34,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7,8]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0327789","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,8]]}}}