Nosocomial fever of unknown origin

This study described the demographics, etiology, and prognosis of nosocomial fever of unknown origin (FUO) using a retrospective study design. The study sites included a university-controlled, tertiary referral teaching hospital, a university-associated Veterans Administration Hospital, and a large tertiary referral private hospital. The subjects included 141 patients with nosocomial FUO, which was defined as (1) fever ≥38.3°C on three or more occasions in a hospitalized patient receiving short-term care; (2) infection not present or incubating on admission; and (3) uncertain diagnosis after 3 days despite appropriate investigation, including at least a 2-day incubation of microbiologic cultures. The average age of the study subjects was 57.1 ± 17.9 years; men represented 63.8%, and 65.8% had undergone surgery within 30 days before the infectious diseases (ID) consultation. Average fever duration was 15.7 ± 14.1 days. The main causes of nosocomial FUO were infection (34.8%) and drug fever (17.0%). Undiagnosed cases constituted 22.7% of the patients studied. At last follow-up, 83% of the patients were alive, 8.5% were dead due to other causes, and 8.5% were dead presumably due to nosocomial FUO. Nosocomial FUO is a prevalent medical problem and a relatively frequent cause of ID consultation. A timely diagnosis of the cause of nosocomial FUO can potentially save lives and shorten hospitalization time.

Duke Scholars

Author Daniel John Sexton Medicine, Infectious Diseases