Nosocomial febrile illness in the elderly: frequency, causes, and risk factors
Trivalle, C.; Chassagne, P.; Bouaniche, M.; Landrin, I.; Marie, I.; Kadri, N.; Menard, J.F.; Lemeland, J.F.; Doucet, J.; Bercoff, E.
Archives of Internal Medicine 158(14): 1560-1565
1998
ISSN/ISBN: 0003-9926 PMID: 9679797 Document Number: 493021
Background: Although nosocomial febrile illness (NFI) is common in hospitalized patients, it has been less extensively studied in the elderly. Objective: To determine the frequency, causes, and risk factors of NFI in elderly inpatients. Methods: This prospective study involved 608 patients (gtoreq65 years of age) admitted in an acute geriatric unit. Investigators followed this cohort until 1 of the following events occurred: development of NFI, discharge from the geriatric unit, or death. The cause of NFI was classified into 3 groups: infectious, noninfectious, and no apparent diagnosis. We systematically studied 17 comorbid conditions, 6 drugs, and 7 invasive procedures. For comparison, the patients were stratified into 2 groups: patients with NFI and patients without NFI. Results: Sixty-six patients (10.9%) with NFI were identified. They were compared with the remaining 542 patients without NFI. In 49 patients (74%) with NFI, the cause was infectious; in 9 (13.5%), it was noninfectious; and in 8 (12.5%), there was no apparent cause. After multivariate analysis, only fecal incontinence (odds ratio (OR), 5.54; 95% confidence interval (CI), 2.13-14.5), congestive heart failure (OR, 2.97; 95% CI, 1.53-5.76), and pressure ulcers (OR, 2.93; 95% CI, 1.19-7.17) were independent risk factors for NFI. The number of invasive procedures preceding the febrile episode was a significant predictor of infection (OR, 3.68; 95% CI, 1.14-9.21). Conclusions: Nosocomial febrile illness is a common event in elderly hospitalized patients. In 74% of the patients with NFI, an infection is found. Measures to decrease infectious NFI in the elderly require a reduction in the number of invasive procedures.