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 - Scorecard - 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 Scorecard: Impact of Daily Body Temperature, White Blood Cell Levels, and C-reactive Protein on Mortality and Ongoing Bacteremia in Staphylococcus Aureus Bacteremia Patients: Insights from a Post Hoc Analysis of the CAMERA2 Trial

At a Glance

CategoryDetail
ConditionMethicillin-resistant Staphylococcus aureus (MRSA) bacteremia
Key MechanismsDaily body temperature, white blood cell count, and C-reactive protein levels as prognostic markers
Target PopulationHospitalized adult patients with MRSA bacteremia
Care SettingHospital inpatient setting

Key Highlights

  • Persistent fever (≥38.0 °C) after 72 hours is strongly associated with increased 90-day mortality in MRSA bacteremia patients.
  • C-reactive protein and white blood cell count did not show consistent or temporal association with mortality.
  • Fever later in the illness course (day 7) had higher adjusted odds of mortality compared to earlier days.

Guideline-Based Recommendations

Diagnosis

  • Use persistent fever >72 hours as a criterion to classify patients as high-risk or complicated SAB.
  • Consider positive follow-up blood cultures after 48 hours and clinical variables for SAB classification.

Management

  • Classify SAB as complicated or uncomplicated to guide duration of therapy (2 weeks for uncomplicated, 4–6 weeks for complicated).
  • Avoid overtreatment by refining risk stratification algorithms incorporating persistent fever.

Monitoring & Follow-up

  • Monitor daily body temperature during the first week of illness to identify persistent fever.
  • Collect peripheral blood WBC and CRP on days 2, 5, and 7, though these have limited predictive value for mortality.

Risks

  • Persistent fever beyond 72 hours indicates higher mortality risk and may warrant intensified management.
  • Overclassification of complicated SAB may lead to unnecessary prolonged antibiotic therapy.

Patient & Prescribing Data

Hospitalized adults with MRSA bacteremia enrolled in the CAMERA2 trial

Combination therapy with standard anti-MRSA agents plus intravenous β-lactams was studied, but no significant difference in primary composite endpoint was observed; persistent fever remains a key prognostic indicator.

Clinical Best Practices

  • Use persistent fever ≥38.0 °C after 72 hours as a key marker for complicated SAB risk stratification.
  • Incorporate daily temperature monitoring into routine care for SAB patients to guide prognosis and management.
  • Do not rely solely on CRP or WBC counts for mortality risk prediction in MRSA bacteremia.
  • Align timing of clinical and laboratory assessments to the index positive blood culture date for consistent evaluation.

References

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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