Association of Daily Body Temperature, White Blood Cell Count, and C-reactive Protein With Mortality and Persistent Bacteremia in Patients With Staphylococcus Aureus Bacteremia: A Post Hoc Analysis of the CAMERA2 Randomized Clinical Trial - Report - MDSpire

Association of Daily Body Temperature, White Blood Cell Count, and C-reactive Protein With Mortality and Persistent Bacteremia in Patients With Staphylococcus Aureus Bacteremia: A Post Hoc Analysis of the CAMERA2 Randomized Clinical Trial

  • By

  • Sean W X Ong

  • Nick Daneman

  • Joshua S Davis

  • Steven Y C Tong

  • for the Combination Antibiotics for MEthicillin Resistant Staphylococcus aureus (CAMERA2) Study Group

  • David C Lye

  • Dafna Yahav

  • Archana Sud

  • J Owen Robinson

  • Jane Nelson

  • Sophia Archuleta

  • Matthew A Roberts

  • Alan Cass

  • David L Paterson

  • Hong Foo

  • Mical Paul

  • Stephen D Guy

  • Adrian R Tramontana

  • Genevieve B Walls

  • Stephen McBride

  • Narin Bak

  • Niladri Ghosh

  • Benjamin A Rogers

  • Anna P Ralph

  • Jane Davies

  • Patricia E Ferguson

  • Ravindra Dotel

  • Genevieve L McKew

  • Timothy J Gray

  • Natasha E Holmes

  • Simon Smith

  • Morgyn S Warner

  • Shirin Kalimuddin

  • Barnaby E Young

  • Naomi Runnegar

  • David N Andresen

  • Nicholas A Anagnostou

  • Mark D Chatfield

  • Allen C Cheng

  • Vance G Fowler

  • Benjamin P Howden

  • Niamh Meagher

  • David J Price

  • Sebastiaan J van Hal

  • Matthew V N O Sullivan

  • January 30, 2025

  • 0 min

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Clinical Report: Daily Fever Predicts Mortality in MRSA Bacteremia Patients

Overview

In patients with methicillin-resistant Staphylococcus aureus bacteremia, persistent fever (≥38.0 °C) from day 4 of illness onwards is strongly associated with increased 90-day mortality. In contrast, white blood cell counts and C-reactive protein levels did not consistently predict mortality or ongoing bacteremia.

Background

Staphylococcus aureus bacteremia (SAB) carries significant morbidity and mortality, necessitating accurate risk stratification to guide treatment duration. Current guidelines classify SAB as complicated or uncomplicated based on clinical and microbiologic criteria, including persistent fever and follow-up blood cultures. However, these criteria may lack precision, potentially leading to overtreatment. This study explores whether daily body temperature, WBC, and CRP can improve risk stratification in SAB patients.

Data Highlights

ParameterTiming (Day of Illness)Association with 90-day Mortality (Adjusted OR, 95% CI)
Fever (≥38.0 °C)Day 43.70 (1.58–8.67)
Fever (≥38.0 °C)Day 78.78 (2.78–27.7)
CRP (≥50 mg/L)Days 2, 5, 7No consistent association
WBC (abnormal)Days 2, 5, 7No consistent association

Key Findings

  • Persistent fever (≥38.0 °C) from day 4 onwards significantly increases odds of 90-day mortality in MRSA bacteremia patients.
  • The strength of association between fever and mortality increases over time, with the highest adjusted odds ratio on day 7.
  • CRP levels ≥50 mg/L do not show a consistent or temporal relationship with mortality in this cohort.
  • Abnormal white blood cell counts similarly lack consistent predictive value for mortality or persistent bacteremia.
  • Persistent fever after 72 hours supports its use as a criterion for classifying SAB as complicated or high-risk.

Clinical Implications

Clinicians should closely monitor body temperature trends in patients with MRSA bacteremia, as persistent fever beyond 72 hours is a strong indicator of increased mortality risk and complicated infection. Routine measurement of CRP and WBC counts may have limited utility in risk stratification for mortality or ongoing bacteremia in this setting. Incorporating persistent fever into risk algorithms can help guide decisions on treatment duration and intensity.

Conclusion

Persistent fever is a valuable prognostic marker in MRSA bacteremia, strongly associated with mortality, whereas CRP and WBC counts provide limited additional predictive information. These findings support maintaining fever as a key criterion in SAB risk stratification.

References

  1. CAMERA2 Trial Investigators 2024 -- Impact of Daily Body Temperature, WBC, and CRP on Mortality in MRSA Bacteremia

Original Source(s)

Association of Daily Body Temperature, White Blood Cell Count, and C-reactive Protein With Mortality and Persistent Bacteremia in Patients With Staphylococcus Aureus Bacteremia: A Post Hoc Analysis of the CAMERA2 Randomized Clinical Trial

  • by Sean W X Ong, Nick Daneman, Joshua S Davis, Steven Y C Tong, for the Combination Antibiotics for MEthicillin Resistant Staphylococcus aureus (CAMERA2) Study Group, David C Lye, Dafna Yahav, Archana Sud, J Owen Robinson, Jane Nelson, Sophia Archuleta, Matthew A Roberts, Alan Cass, David L Paterson, Hong Foo, Mical Paul, Stephen D Guy, Adrian R Tramontana, Genevieve B Walls, Stephen McBride, Narin Bak, Niladri Ghosh, Benjamin A Rogers, Anna P Ralph, Jane Davies, Patricia E Ferguson, Ravindra Dotel, Genevieve L McKew, Timothy J Gray, Natasha E Holmes, Simon Smith, Morgyn S Warner, Shirin Kalimuddin, Barnaby E Young, Naomi Runnegar, David N Andresen, Nicholas A Anagnostou, Mark D Chatfield, Allen C Cheng, Vance G Fowler, Benjamin P Howden, Niamh Meagher, David J Price, Sebastiaan J van Hal, Matthew V N O Sullivan

  • January 30, 2025

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