Infectious Causes of Fever in the CCU
Most infections that are not toxin mediated elicit a febrile response. While all infections do not
manifest temperatures > 1028 F, they have the potential to be > 1028 F, e.g., nosocomial
pneumonia may be associated with temperatures< 1028 F or >102 8 F. Although all infectious
diseases will not present with temperatures 1028 F, they are the disorders most frequently
associated with temperatures in the 102 8 F–106 8 F range. Infectious diseases encountered in the
CCU usually associated with temperatures 1028 F include postoperative abscesses, acute
meningitis, acute encephalitis, brain abscess, suppurative thrombophlebitis, jugular septic vein
thrombophlebitis, septic pelvic thrombophlebitis, septic pulmonary emboli, pericarditis, acute
bacterial endocarditis, perivalvular/myocardial abscess, community-acquired pneumonia
(CAP), pleural empyema, lung abscess, cholangitis, intrarenal/perinephric abscess, prostatic
abscess, urosepsis, central-line infections, contaminated infusates, pylephlebitis, liver abscess,
C. difficilecolitis, complicated skin and soft tissue infections/abscesses, AV graft infections,
foreign body–related infections [infected pacemakers, defibrillators, semipermanent central
intra-venous (IV) catheters, Hickman/Broviac catheters], and septic arthritis. Infectious
diseases likely to be seen in the ICU setting with temperatures< 1028 F include osteomyelitis,
sacral decubitus ulcers, uncomplicated wound infections, cellulitis, etc. (5,19,21,23).
The clinician should analyze the fever relationships in the clinical context and correlate
these findings with other aspects of the patient’s clinical condition to arrive at a likely cause for
the temperature elevation. The clinical approach utilizes not only the height of the fever but the
abruptness of onset, the characteristics of the fever curve, the duration of the fever, and
defervescence pattern, all of which have diagnostic importance (Table 5) (5).
SINGLE FEVER SPIKES >102 ̊F
Patients in the CCU who have been afebrile or had low-grade fevers, i.e., 1028 F may
suddenly develop a single fever spike> 1028 F. Single fever spikes are never infectious in
origin. The causes of single fever spikes include insertion/removal of a urinary catheter,
insertion/removal of a venous catheter, suctioning/manipulation of an endotracheal tube,
wound packing/lavage, wound irrigation, etc. Any manipulative procedure that involves a
Table 4 Clinical Approach to Fever in CCU
Early infectious disease consultation
. All critically ill febrile CCU patients should have infectious disease consultation
. Infectious disease consultation also useful to evaluate mimics of infection (pseudosepsis) and interpretation
of complex microbiologic data
Low-grade fevers ( 1028 F)
. Noninfectious disorders most likely causes of low-grade fevers
Common medical disorders with fevers 1028 F in CCU:
MI/CHF Hematomas
Pulmonary embolus/infarction GI hemorrhage
Acute pancreatitis Cholecystitis
Atelectasis/dehydration Uncomplicated wound infections
Thrombophlebitis
. Infectious diseases are less likely causes
High spiking fevers ( 1028 F) in CCU:
. Infectious cause most likely
Most common causes ofnoninfectious fevers 1028 F in CCU:
. Drug fevers
. Malignant neuroleptic syndrome
. Central fevers
. Relative adrenal insufficiency
. SLE flare
. Vasculitis
. Blood transfusion
. Transient bacteremias (2 8 to manipulation of colonized/infected mucosa surface)
6 Cunha