Brief report: incidence, etiology, risk factors, and outcome of hospital-acquired fever: a systematic, evidence-based review.
OBJECTIVE
Temperature is universally measured in the hospitalized patient, but the literature on hospital-acquired fever has not been systematically reviewed. This systematic review is intended to provide clinicians with an overview of the incidence, etiology, and outcome of hospital-acquired fever.


METHODS
We searched MEDLINE (1970 to 2005), EMBASE (1988 to 2004), and Web of Knowledge. References of all included articles were reviewed. Articles that focused on children, fever in the developing world, classic fever of unknown origin, or specialized patient populations were excluded.


METHODS
Articles were reviewed independently by 2 authors before inclusion; a third author acted as arbiter.


RESULTS
Of over 1,000 studies reviewed, 7 met the criteria for inclusion. The incidence of hospital-acquired fever ranged from 2% to 17%. The etiology of fever was infection in 37% to 74%. Rates of antibiotic use for patients with a noninfectious cause of fever ranged from 29% to 55% for a mean duration of 6.6 to 9.6 days. Studies varied widely in their methodology and the patient population studied.


CONCLUSIONS
Limited information is available to guide an evidence-based approach to hospital-acquired fever. We propose criteria to help standardize future studies of this important clinical situation.
Kaul
Daniel R
DR
Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109-0378, USA. kauld@umich.edu
Flanders
Scott A
SA
Beck
James M
JM
Saint
Sanjay
S
D015331:Cohort Studies; D003428:Cross Infection / Q000150:complications / Q000453:epidemiology*; D005334:Fever / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D017063:Outcome Assessment, Health Care / Q000592:standards / Q000639:trends; D012307:Risk Factors; D016896:Treatment Outcome