title: Etiology and workup of fevers in gynecologic oncology patients.
abstract: OBJECTIVE
  The objectives of this study are to identify the characteristics of febrile gynecologic oncology patients and to evaluate the utility of common diagnostic procedures used to assess the etiologies of their fevers.
  
  
  METHODS
  Retrospective data were collected for 200 consecutive patients admitted to the gynecologic oncology service at 1 institution between January 2008 and December 2012 for a diagnosis of fever. Data were collected using contingency tables, and the χ test was used as appropriate.
  
  
  RESULTS
  Of the patients admitted for evaluation of fever, 142 (71%) of 200 had a documented fever during hospitalization. The most common etiologies of fever in this population were urinary tract infections (28%) and bloodstream infections (27%), whereas 24% of those admitted for fever did not have a source identified. Abdominal/pelvic computed tomography (CT) scans established the etiology of fever in 53 (60%) of the 89 patients tested, whereas chest x-ray and chest CT were diagnostic for 6% and 21%, respectively. Blood and urine cultures were diagnostic in 29% and 32% of cases, respectively. Patients admitted within 30 days of surgery had a higher percentage of wound infections (38% vs 10%, P < 0.001) as compared with those admitted for more than 30 days after surgery.
  
  
  CONCLUSIONS
  The initial evaluation of the febrile gynecologic oncology patient without obvious source by history and examination should include urinalysis with reflex culture and blood cultures. Abdominopelvic and chest CT may be useful when fever persists and initial assessment is unrevealing. Chest x-ray is commonly done but infrequently diagnostic. Wound exploration may be important in patients with fevers for more than 30 days after surgery.
authors.affiliation: Departments of *Obstetrics and Gynecology, and †Internal Medicine, University of Washington, Seattle, WA; and ‡Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, St Louis, MO.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: McCartney
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Sabo
authors.forename: L Stewart
authors.initials: LS
authors.lastname: Massad
authors.forename: Andrea R
authors.initials: AR
authors.lastname: Hagemann
authors.forename: David G
authors.initials: DG
authors.lastname: Mutch
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Powell
authors.forename: Premal H
authors.initials: PH
authors.lastname: Thaker
authors.forename: Akiva P
authors.initials: AP
authors.lastname: Novetsky
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy / Q000009:adverse effects*; D005260:Female; D005334:Fever / Q000175:diagnosis* / Q000209:etiology*; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000150:complications* / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies