caa a22 4500 606157182 CHVBK 20210128100612.0 cr unu---uuuuu 210128e20150401xx s 000 0 eng 10.1007/s10096-014-2288-3 doi (NATIONALLICENCE)springer-10.1007/s10096-014-2288-3 The significance of persistent fever in the treatment of suspected bacterial infections among inpatients: a prospective cohort study [Elektronische Daten] [A. Neuberger, D. Yahav, V. Daitch, Y. Akayzen, L. Farbman, T. Avni, L. Leibovici, M. Paul] Antibiotic escalations are frequently guided by fever persistence. Unnecessary antibiotic escalation is associated with resistance induction. We examined whether fever persistence is associated with adverse outcomes among medical inpatients with sepsis. In a single-center prospective cohort study, we included consecutive medical inpatients with suspected or documented bacterial infections. Data were collected on days 0, 2, 4, and 30days from episode onset. We examined the association between fever persistence at 4days and 30-day mortality on univariate and multivariate analysis. Inappropriate empirical antibiotic treatment (IAET) was defined for patients with microbiologically documented infections (MDIs). Odds ratios (ORs) are presented with 95% confidence intervals (CIs). A total of 1,621 patients were included. Among patients with MDIs, 38/206 (18.4%) given appropriate empiric therapy had continued fever on day 4, compared to 64/231 (27.7%) of patients receiving IAET, OR 0.59, 95% CI 0.37-0.93. Fever persistence was not associated with mortality after adjustment for other risk factors. Among patients with presumed sepsis who did not have MDIs, persistent fever was significantly associated with 30-day mortality on a multivariate analysis, adjusted OR 2.77 (95% CI 1.78-4.31). Other risk factors for mortality included older age, nosocomial infections, malignancy, dyspnea, shock, decreased albumin, and elevated creatinine. For patients with MDIs, fever persistence for up to 4days is a marker of IAET, but is not associated with mortality, and should not, in itself, trigger antibiotic escalation. For patients without MDIs, fever persistence should trigger careful re-evaluation, as it is associated with mortality. Springer-Verlag Berlin Heidelberg, 2014 Neuberger A. Unit of Infectious Diseases and Internal Medicine B, Rambam Health Care Campus, The Ruth and Bruce Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, 8 Haalya Hashnya St., 33705, Haifa, Israel aut Yahav D. Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel aut Daitch V. Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel aut Akayzen Y. Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel aut Farbman L. Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel aut Avni T. Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel aut Leibovici L. Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel aut Paul M. Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel aut European Journal of Clinical Microbiology & Infectious Diseases Springer Berlin Heidelberg 34/4(2015-04-01), 805-810 0934-9723 34:4<805 2015 34 10096 https://doi.org/10.1007/s10096-014-2288-3 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s10096-014-2288-3 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Neuberger A. Unit of Infectious Diseases and Internal Medicine B, Rambam Health Care Campus, The Ruth and Bruce Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, 8 Haalya Hashnya St., 33705, Haifa, Israel aut NATIONALLICENCE 700 1- Yahav D. Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel aut NATIONALLICENCE 700 1- Daitch V. Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel aut NATIONALLICENCE 700 1- Akayzen Y. Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel aut NATIONALLICENCE 700 1- Farbman L. Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel aut NATIONALLICENCE 700 1- Avni T. Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel aut NATIONALLICENCE 700 1- Leibovici L. Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel aut NATIONALLICENCE 700 1- Paul M. Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel aut NATIONALLICENCE 773 0- European Journal of Clinical Microbiology & Infectious Diseases Springer Berlin Heidelberg 34/4(2015-04-01), 805-810 0934-9723 34:4<805 2015 34 10096