Primary Treatment for Fever Due to Infection

Diagnostic Approach

Fever is a common early indicator of infection, occurring in 26-88% of adult ICU patients, and represents a physiologic mechanism that has beneficial effects in fighting infection rather than being a primary illness itself 3
Determine whether fever represents initial onset, persistent unexplained fever (after 4-7 days), or a recurrent episode, and aggressively determine the etiology through appropriate cultures and diagnostic tests before initiating therapy when possible 4, 3
Central temperature monitoring methods (thermistors for pulmonary artery catheters, bladder catheters, or esophageal balloon thermistors) are preferred when accurate temperature measurements are critical 3
Blood cultures should be obtained before initiating antimicrobial therapy, especially if the patient is seriously ill or deteriorating 1, 2

Initiate empiric therapy when clinical evaluation suggests infection is the cause of fever, especially if the patient is seriously ill or deteriorating 1, 2
Begin antimicrobial therapy within 1 hour after the diagnosis of sepsis is considered, and therapy may be necessary for unstable or high-risk patients while diagnostic evaluation is ongoing 1
Direct initial empiric antibiotic therapy against likely pathogens based on suspected source of infection, patient risk for multidrug-resistant pathogens, and local antimicrobial susceptibility patterns 1, 2
For patients with neutropenia and fever, hospitalization and empiric antibacterial therapy with vancomycin plus antipseudomonal antibiotics is recommended, and for persistent or recurrent episodes, add empiric antifungal therapy 4, 5, 6

Documented clinical and microbiologic infections should be treated based on antimicrobial susceptibilities of isolated organisms once available, and treatment duration for most bacterial skin and soft tissue infections should be 7-14 days 4, 5
Non-infectious causes of fever should always be considered in the differential diagnosis, including drug fever, withdrawal syndromes, and inflammatory conditions 1, 3, 2
Delay of effective antimicrobial therapy has been associated with increased mortality from infection and sepsis, and for patients with drug-resistant pathogens, initial broad-spectrum empirical antimicrobial therapy directed against both resistant Gram-positive cocci and Gram-negative bacilli may be required 1, 2