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- Title
Nosocomial Fever in General Medical Wards: A Prospective Cohort Study of Clinical Characteristics and Outcomes.
- Authors
Dankul, Parita; Karaketklang, Khemajira; Jitmuang, Anupop
- Abstract
Purpose: Nosocomial fever (NF) is a common sign of healthcare-associated infection; however, infection is not always followed up. We studied the etiology, clinical characteristics, and outcomes of nosocomial fever in hospitalized patients. Patients and Methods: Between October 2019 and December 2020, we enrolled subjects from general medical wards who developed fever ≥ 48 hours after hospital admission or who were admitted with fever, defervesced, and then developed a fever ≥ 7 days later that was unrelated to the cause for admission. Subjects with NF underwent a comprehensive clinical evaluation and laboratory investigations. Results: Eighty-six cases of NF were identified and completely followed, the mean age was 69.29 years, and 35 were male. Fifty-seven were from infectious etiologies, 28 from non-infectious etiologies, and one case was unable to be determined. Hospital-associated pneumonia (47.4%) and urinary tract infection (22.8%) were the most common infectious causes, and malignancy (17.8%) and large hematoma (14.3%) were the most common non-infectious causes. The median day of onset of NF following hospitalization was 12 (4.7– 21.2) days. Acute physiology and chronic health evaluation II (APACHE II) score (14.70 vs 11.97, p = 0.02), sequential organ failure assessment (SOFA) scores (4 vs 2, p < 0.01), pertinent clinical findings (82.5% vs 42.9%, p < 0.01), blood urea nitrogen (BUN) (37.30 vs 21.10, p = 0.03) and creatinine (1.41 vs 0.97, p = 0.05) levels, and abnormal chest radiography (45.6% vs 3.6%, p < 0.01) had significant differences between infectious and non-infectious etiologies. Twenty-three subjects (26.7%) died. The presence of end-stage renal disease (ESRD) [OR 19.49 (1.77– 214.18), p = 0.015], SOFA score > 6 [OR 5.18 (1.04– 25.90), p = 0.045], and abnormal chest radiography [OR 3.45 (1.16– 10.29), p = 0.026] were significantly associated with mortality. Conclusion: Nosocomial infections, malignancy, and hematoma were the leading causes of NF. Severity scores, clinical findings, renal function tests, and chest radiography were distinguishing features between infectious and non-infectious etiologies. ESRD, high SOFA scores, and abnormal chest radiography were associated with mortality.
- Subjects
APACHE (Disease classification system); TREATMENT effectiveness; NOSOCOMIAL infections; URINARY tract infections; COVID-19; FEVER; BLOOD urea nitrogen
- Publication
Infection & Drug Resistance, 2021, Vol 14, p3873
- ISSN
1178-6973
- Publication type
Article
- DOI
10.2147/IDR.S328395