title: Role of body temperature in diagnosing bacterial infection in nursing home residents.
abstract: OBJECTIVE
  To provide empirically based recommendations for incorporating body temperature into clinical decision-making regarding diagnosing infection in nursing home (NH) residents.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  Twelve North Carolina NHs.
  
  
  METHODS
  NH residents (N = 1,007) with 1,858 randomly selected antibiotic prescribing episodes.
  
  
  METHODS
  Maximum prescription-day temperature plus the three most recent nonillness temperatures were recorded for each prescribing episode. Two empirically based definitions of fever were developed: population-based (population mean nonillness temperature plus 2 population standard deviations (SDs)) and individualized (individual mean nonillness temperature plus 2 population SDs). These definitions were used along with previously published fever criteria and Infectious Diseases Society of America (IDSA) criteria to determine how often each prescribing episode was associated with a "fever" according to each definition.
  
  
  RESULTS
  Mean population nonillness temperature was 97.7 ± 0.5 ºF. If "normal" were defined as less than 2 SDs above the mean, fever would be defined as any temperature above 98.7 ºF, and the previously published fever cutpoints and the IDSA criteria are 4.8 SDs above this mean. Between 30% and 32% of the 1,858 prescribing episodes examined were associated with temperatures more than 2 SDs above the population mean nonillness temperature, whereas only 10% to 11% of episodes met the previously published and IDSA fever definitions.
  
  
  CONCLUSIONS
  Clinicians should apply empirically based definitions to assess fever in NH residents. Furthermore, low fever prevalence in residents treated with antibiotics according to all definitions suggests that some prescribing may not be associated with acute bacterial infection.
authors.forename: Philip D
authors.initials: PD
authors.lastname: Sloane
authors.forename: Christine
authors.initials: C
authors.lastname: Kistler
authors.forename: C Madeline
authors.initials: CM
authors.lastname: Mitchell
authors.forename: Anna S
authors.initials: AS
authors.lastname: Beeber
authors.forename: Rosanna M
authors.initials: RM
authors.lastname: Bertrand
authors.forename: Alrick S
authors.initials: AS
authors.lastname: Edwards
authors.forename: Lauren E W
authors.initials: LE
authors.lastname: Olsho
authors.forename: Louise S
authors.initials: LS
authors.lastname: Hadden
authors.forename: James R
authors.initials: JR
authors.lastname: Bateman
authors.forename: Sheryl
authors.initials: S
authors.lastname: Zimmerman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy; D001831:Body Temperature; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D009735:Nursing Homes; D012189:Retrospective Studies