Trivalle C, Chassagne P, Bouaniche M, Landrin I, Marie I, Kadri N, Menard J F, Lemeland J F, Doucet J, Bercoff E
Department of Gerontology, Centre Hospitalier and Universitaire de Rouen, France.
Arch Intern Med. 1998 Jul 27;158(14):1560-5. doi: 10.1001/archinte.158.14.1560.
Although nosocomial febrile illness (NFI) is common in hospitalized patients, it has been less extensively studied in the elderly.
To determine the frequency, causes, and risk factors of NFI in elderly inpatients.
This prospective study involved 608 patients (> or = 65 years of age) admitted in an acute geriatric unit. Investigators followed this cohort until 1 of the following events occurred: development of NFI, discharge from the geriatric unit, or death. The cause of NFI was classified into 3 groups: infectious, noninfectious, and no apparent diagnosis. We systematically studied 17 comorbid conditions, 6 drugs, and 7 invasive procedures. For comparison, the patients were stratified into 2 groups: patients with NFI and patients without NFI.
Sixty-six patients (10.9%) with NFI were identified. They were compared with the remaining 542 patients without NFI. In 49 patients (74%) with NFI, the cause was infectious; in 9 (13.5%), it was noninfectious; and in 8 (12.5%), there was no apparent cause. After multivariate analysis, only fecal incontinence (odds ratio [OR], 5.54; 95% confidence interval [CI], 2.13-14.5), congestive heart failure (OR, 2.97; 95% CI, 1.53-5.76), and pressure ulcers (OR, 2.93; 95% CI, 1.19-7.17) were independent risk factors for NFI. The number of invasive procedures preceding the febrile episode was a significant predictor of infection (OR, 3.68; 95% CI, 1.14-9.21).
Nosocomial febrile illness is a common event in elderly hospitalized patients. In 74% of the patients with NFI, an infection is found. Measures to decrease infectious NFI in the elderly require a reduction in the number of invasive procedures.
虽然医院获得性发热性疾病（NFI）在住院患者中很常见，但在老年人中对其研究较少。
确定老年住院患者中NFI的发生率、病因及危险因素。
这项前瞻性研究纳入了608例入住急性老年病房的患者（年龄≥65岁）。研究人员对该队列进行随访，直至发生以下事件之一：NFI的发生、从老年病房出院或死亡。NFI的病因分为3组：感染性、非感染性和无明确诊断。我们系统地研究了17种合并症、6种药物和7种侵入性操作。为进行比较，将患者分为2组：NFI患者和无NFI患者。
确定了66例（10.9%）NFI患者。将他们与其余542例无NFI患者进行比较。在49例（74%）NFI患者中，病因是感染性的；9例（13.5%）为非感染性；8例（12.5%）无明确病因。多因素分析后，仅大便失禁（比值比[OR]，5.54；95%置信区间[CI]，2.13 - 14.5）、充血性心力衰竭（OR，2.97；95% CI，1.53 - 5.76）和压疮（OR，2.93；95% CI，1.19 - 7.17）是NFI的独立危险因素。发热发作前侵入性操作的数量是感染的重要预测因素（OR，3.68；95% CI，1.14 - 9.21）。
医院获得性发热性疾病在老年住院患者中是常见事件。在74%的NFI患者中发现感染。减少老年人感染性NFI的措施需要减少侵入性操作的数量。
