Toltzis P, Rosolowski B, Salvator A
Department of Pediatrics, Case Western Reserve University School of Medicine, and Rainbow Babies and Children's Hospital of the University Hospitals of Cleveland, Cleveland, Ohio, USA.
Infect Control Hosp Epidemiol. 2001 Aug;22(8):499-504. doi: 10.1086/501940.
To determine the cause of fever in critically ill children and to identify opportunities for reducing antibiotic use in this population.
Prospective case series.
A tertiary-care medical-surgical pediatric intensive care unit (PICU).
Children admitted to the PICU who experienced fever (axillary temperature >38.3 degrees C).
Consecutive children who were febrile at any point in their PICU stay were investigated over two winter seasons. Etiology of the fever was determined by physical examination and routine microbiology and radiographic tests. Three subgroups were reviewed to approximate the number of antibiotic-days that could have been reduced; namely, those with an indeterminate source, those with a documented viral infection, and those receiving a prolonged course of antibiotics. A set of standards reflecting common antibiotic use then was applied to these three patient groups.
Of 211 subjects, the majority (83.3%) had either a definitive or suspected focus for their fever, and nearly all of these patients were judged to have an infectious etiology. The study population received a total of 2,036 antibiotic-days. Despite the high incidence of infectious causes of fever in our subjects, however, approximately 15% of total antibiotic-days could have been reduced by applying common-use standards.
Fever in the PICU was usually of defined focus and infectious in origin. However, among febrile patients in the PICU, substantial opportunity exists for reduction of antibiotic use. Trials determining the safety of antibiotic reduction in this population should be pursued vigorously.
确定重症患儿发热的原因，并找出减少该人群抗生素使用的机会。
前瞻性病例系列研究。
一家三级医疗的小儿内科-外科重症监护病房（PICU）。
入住PICU且出现发热（腋温>38.3摄氏度）的儿童。
在两个冬季对PICU住院期间任何时间出现发热的连续患儿进行调查。通过体格检查、常规微生物学和影像学检查确定发热病因。对三个亚组进行评估，以估算可能减少的抗生素使用天数；即病因不明者、已记录病毒感染者以及接受长期抗生素治疗者。然后将一套反映常用抗生素使用情况的标准应用于这三组患者。
在211名研究对象中，大多数（83.3%）发热有明确或可疑的病灶，且几乎所有这些患者都被判定有感染性病因。研究人群共接受了2036个抗生素使用日。然而，尽管我们的研究对象中发热的感染性病因发生率很高，但通过应用常用标准，约15%的抗生素使用日是可以减少的。
PICU中的发热通常有明确病灶且源于感染。然而，在PICU的发热患者中，存在大量减少抗生素使用的机会。应积极开展确定该人群减少抗生素使用安全性的试验。
