NOSOCOMIAL FEBRILE ILLNESS IN THE ELDERLY - FREQUENCY, CAUSES, AND RISK-FACTORS

Background: Although nosocomial febrile illness (NFI) is common in hos pitalized patients, it has been less extensively studied in the elderl y. Objective: To determine the frequency, causes, and risk factors of NFI in elderly inpatients. Methods: This prospective study involved 60 8 patients (greater than or equal to 65 years of age) admitted in an a cute geriatric unit. Investigators followed this cohort until 1 of the following events occurred: development of NFI, discharge from the ger iatric unit, or death. The cause of NFI was classified into 3 groups: infectious, noninfectious, and no apparent diagnosis. We systematicall y studied 17 comorbid conditions, 6 drugs, and 7 invasive procedures. For comparison, the patients were stratified into 2 groups: patients w ith NFI and patients without NFI. Results: Sixty-six patients (10.9%) with NFI were identified. They were compared with the remaining 542 pa tients without NFI. In 49 patients (74%) with NFI, the cause was infec tious; in 9 (13.5%), it was noninfectious; and in 8 (12.5%), there was no apparent cause. After multivariate analysis, only fecal incontinen ce (odds ratio [OR], 5.54; 95% confidence interval [CII, 2.13-14.5), c ongestive heart failure (OR, 2.97; 95% CI, 1.53-5.76), and pressure ul cers (OR, 2.93; 95% CI, 1.19-7.17) were independent risk factors for N FI. The number of invasive procedures preceding the febrile episode wa s a significant predictor of infection (OR, 3.68; 95% CI, 1.14-9.21). Conclusions: Nosocomial febrile illness is a common event in elderly h ospitalized patients. In 74% of the patients with NFI, an infection is found. Measures to decrease infectious NFI in the elderly require a r eduction in the number of invasive procedures.