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06%). Six clinical factors, including age over 55 years, moderate to severe CKD, solid organ tumor, liver disease, history of chills, and body temperature of over 38.3 °C, were associated with positive blood culture. Clinical factors at ED arrival can be used as predictors of bloodstream infection. Clinical factors at ED arrival can be used as predictors of bloodstream infection. Kounis syndrome is an acute coronary syndrome that appears in the setting of anaphylactic reaction or hypersensitivity. Many drugs and environmental exposures