title: Clinical and demographic factors associated with antipyretic use in gram-negative severe sepsis and septic shock.
abstract: BACKGROUND
  Antipyretic therapy is commonly prescribed for patients with infection, but studies of its impact on clinical outcomes have yielded mixed results. No data exist to characterize the use of antipyretic medications in patients with severe sepsis or septic shock.
  
  
  OBJECTIVE
  To identify clinical and demographic factors associated with antipyretic medication administration in severe sepsis and septic shock.
  
  
  METHODS
  This single-center, retrospective, cohort study assessed febrile patients (temperature ≥ 38.3 °C) with gram-negative severe sepsis or septic shock at an 1111-bed academic medical center between January 2002 and February 2008. Patients were excluded if they had liver disease, acute brain injury, or allergy to acetaminophen. Generalized estimating equations were used to estimate the effect of clinical factors on treatment of patients with antipyretic medications.
  
  
  RESULTS
  Although 76% of patients in this febrile cohort (n = 241) were prescribed an antipyretic agent, only 42% received antipyretic therapy; 95% of the doses were acetaminophen. Variables associated with antipyretic treatment were maximum body temperature (OR 2.11, 95% CI 1.53 to 2.89), time after sepsis diagnosis (OR 0.88, 95% CI 0.82 to 0.95), surgery during hospitalization (OR 0.49, 95% CI 0.31 to 0.80), death within 36 hours (OR 0.35, 95% CI 0.15 to 0.85), and mechanical ventilation (OR 0.58, 95% CI 0.34 to 0.98). Severity of illness factors, demographic factors, and patient treatment location did not predict who would receive antipyretic therapy.
  
  
  CONCLUSIONS
  Most febrile episodes in patients with gram-negative severe sepsis or septic shock were not treated with antipyretic medications. Further studies are needed to demonstrate the effect of antipyretics on clinically relevant outcomes in severe sepsis and septic shock.
authors.affiliation: Department of Emergency Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA. nicholas-mohr@uiowa.edu
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Mohr
authors.forename: Brian M
authors.initials: BM
authors.lastname: Fuller
authors.forename: Lee P
authors.initials: LP
authors.lastname: Skrupky
authors.forename: Hawnwan
authors.initials: H
authors.lastname: Moy
authors.forename: Robert
authors.initials: R
authors.lastname: Alunday
authors.forename: Scott T
authors.initials: ST
authors.lastname: Micek
authors.forename: Richard E
authors.initials: RE
authors.lastname: Fagley
mesh_terms: D000046:Academic Medical Centers; D000082:Acetaminophen / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D058633:Antipyretics / Q000627:therapeutic use*; D016470:Bacteremia / Q000150:complications / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology*; D015331:Cohort Studies; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D017202:Myocardial Ischemia / Q000150:complications / Q000453:epidemiology; D011175:Positive-Pressure Respiration; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000150:complications / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology*
chemical_list: D058633:Antipyretics; D000082:Acetaminophen