Etiology of fever and opportunities for reduction of antibiotic use in a pediatric intensive care unit

OBJECTIVE: To determine the cause of fever in critically ill children and t o identify opportunities for reducing antibiotic use in this population. DESIGN: Prospective case series. SETTING: A tertiary-care medical-surgical pediatric intensive care unit (PI CU). PATIENTS: Children admitted to the PICU who experienced fever (axillary tem perature > 38.3 degreesC). MEASUREMENTS: Consecutive children who were febrile at any point in their P ICU stay were investigated over two winter seasons. Etiology of the fever w as determined by physical examination and routine microbiology and radiogra phic tests. Three subgroups were reviewed to approximate the number of anti biotic-days that could have been reduced; namely, those with an indetermina te source, those with a documented viral infection, and those receiving a p rolonged course of antibiotics. A set of standards reflecting common antibi otic use then was applied to these three patient groups. RESULTS: Of 211 subjects, the majority (83.39%) had either a definitive or suspected focus for their fever, and nearly all of these patients were judg ed 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. CONCLUSIONS: Fever in the PICU was usually of defined focus and infectious in origin. However, among febrile patients in the PICU, substantial opportu nity exists for reduction of antibiotic use. Trials determining the safety of antibiotic reduction in this population should be pursued vigorously (In fect Control Hosp Epidemiol 2001;22:499-504).