Is bandemia with a normal WBC count concerning?

 

TL;DR: Bandemia is concerning even in the absence of leukocytosis and/or abnormal temperature

 

Drees et al evaluated whether patients admitted to the hospital with a normal WBC and elevated bands were at higher risk for infection or in-hospital death

-Retrospective cohort study including all admitted patients over a 1 year period

-Included all patients who initially had normal WBC count

-Band groups were defined at normal (<10%), moderate (11-19%), and high (>20%)

-Vitals signs and culture results were obtained via chart review for all patients with bandemia as well as for a random sample of 407 patients with normal band count

-Culture results suggestive of contamination were excluded

Moderate bandemia was associated with having any significant positive culture (adjusted odds ratio 2.0), positive blood culture (adjusted odd ratio 3.8) and increased odds of inpatient mortality (adjusted odds ratio 3.2)

High bandemia was associated with having any significant positive culture (adjusted odds ratio 2.8), positive blood culture (adjusted odd ratio 6.2) and increased odds of inpatient mortality (adjusted odds ratio 4.7)

 

Another paper by Seigel et al aimed to quantify the ability of abnormal temperature, white blood cell count, and bandemia (defined as >5% total bands) to identify bacteremia in ED patients with suspected infection.

-Abnormal temperature (hypo/hyperthermia) had a sensitivity of 67% for culture proven bacteremia

-Abnormal WBC count had a sensitivity of 48% for culture proven bacteremia

-Bandemia had a sensitivity of 82% for culture proven bacteremia

-In patients with bacteremia and hypotension or septic shock, 33% had normal temperature and 21% had normal WBC count on initial evaluation