title: Management of postoperative fever in cardiovascular surgery.
abstract: BACKGROUND
  The causes and management of postoperative fever were studied.
  
  
  METHODS
  During a four-year-period beginning in January of 1991, high fever over 38.5 degrees C max occurred in twenty-five (6%) out of 395 patients who underwent cardiovascular surgery.
  
  
  RESULTS
  Nine of the patients (28%) evidenced bacteriological infections as follows; 3 cases of mediastinitis, 2 cases of respiratory tract infection, 1 case of MRSA colitis and a wound infection in one case. The three patients with mediastinitis died and the two cases of MRSA were detected from the culture of pacemaker leads. Bacteriological infection was not detected in other 18 (72%) patients with fever. However, we speculated that the clinical causes of fever in 9 out of 18 patients were as follows; catheter fever in 3 patients, acalculous cholecystitis in 2, fungus infection in 2, aseptic meningitis in one and viral myelitis in one patient. Two patients with acalculous cholecystitis recovered after percutaneous transhepatic gallbladder drainage. The causes of fever were not apparent in nine patients, however the source might be related to artificial prostheses used intraoperatively in five patients. C-reactive protein (CRP) was elevated beyond 10 mg/dl in 13 (52%) of the 25 patients. CRP increased in all seven bacteriologically positive patients and in six (32%) of the bacteriologically negative patients.
  
  
  CONCLUSIONS
  Precise and prompt bacterial examinations are necessary in patients with CRP elevation because the origins of fever were bacteriological in only 28% of the patients with a high fever. Good prognoses may be obtained by suitable management in bacteriologically negative patients.
authors.affiliation: Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Ishikawa
authors.forename: A
authors.initials: A
authors.lastname: Ohtaki
authors.forename: T
authors.initials: T
authors.lastname: Takahashi
authors.forename: Y
authors.initials: Y
authors.lastname: Sato
authors.forename: T
authors.initials: T
authors.lastname: Koyano
authors.forename: Y
authors.initials: Y
authors.lastname: Hasegawa
authors.forename: T
authors.initials: T
authors.lastname: Yamagishi
authors.forename: T
authors.initials: T
authors.lastname: Ogino
authors.forename: S
authors.initials: S
authors.lastname: Ohki
authors.forename: M
authors.initials: M
authors.lastname: Kamiyoshihara
authors.forename: Y
authors.initials: Y
authors.lastname: Morishita
mesh_terms: D000328:Adult; D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis*; D002097:C-Reactive Protein / Q000032:analysis; D013504:Cardiovascular Surgical Procedures; D005260:Female; D005335:Fever of Unknown Origin / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D009181:Mycoses / Q000150:complications / Q000175:diagnosis; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D019736:Prostheses and Implants / Q000009:adverse effects; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000150:complications / Q000175:diagnosis; D014777:Virus Diseases / Q000150:complications / Q000175:diagnosis
chemical_list: D002097:C-Reactive Protein