Differentiating Central vs Infectious Fever

Diagnostic Approach

Blood cultures should be obtained from at least two sets, with one peripheral and one from suspected catheter if present, as recommended by the Society of Critical Care Medicine 1
Temperature monitoring should use central methods, such as bladder catheter, esophageal thermistor, or PA catheter thermistor, when accurate measurement is critical, as suggested by the Society of Critical Care Medicine 2, 3

For suspected infectious fever, immediate empiric antibiotics should be initiated within 1 hour if sepsis is considered, before culture results, as recommended by the Society of Critical Care Medicine 5
Broad-spectrum coverage should be directed against likely pathogens based on suspected source, risk for multidrug-resistant organisms, and local susceptibility patterns, as recommended by the Society of Critical Care Medicine 5
Source control measures, such as removing infected catheters, draining abscesses, or performing surgical intervention, should be taken as indicated, as recommended by the Society of Critical Care Medicine 1

Delaying antibiotics in septic patients can increase mortality, and empiric antimicrobial therapy should be initiated when clinical distinction is unclear, as recommended by the Society of Critical Care Medicine 5, 6
Non-infectious causes, such as drug fever, withdrawal syndromes, blood transfusion reactions, and other inflammatory states, should be considered in the differential diagnosis, as recommended by the Society of Critical Care Medicine 7, 3, 5
Unreliable temperature methods, such as axillary or tympanic measurements, should be avoided for critical decisions, as recommended by the Society of Critical Care Medicine 2, 3
Atypical presentations, such as severe infections without fever in elderly and immunocompromised patients, should not be overlooked, as recommended by the Society of Critical Care Medicine 1