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Frequency, Causes, and Risk Factors

Christophe Trivalle, MD; Philippe Chassagne, MD; Marc Bouaniche, MD; Isabelle Landrin, MD; Isabelle Marie, MD; Nadir Kadri, MD; Jean-François Menard, MD; Jean-François Lemeland, MD; Jean Doucet, MD; Eric Bercoff, MD

Arch Intern Med. 1998;158:1560-1565.

Background  Although nosocomial febrile illness (NFI) is common in hospitalized patients, it has been less extensively studied in the elderly.

Objective  To determine the frequency, causes, and risk factors of NFI in elderly inpatients.

Methods  This prospective study involved 608 patients (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.

Results  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).

Conclusions  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.

From the Departments of Gerontology (Drs Trivalle, Chassagne, Bouaniche, Landrin, Marie, Kadri, Doucet, and Bercoff) and Statistics (Dr Menard) and the Bacteriology Laboratory (Dr Lemeland), Centre Hospitalier and Universitaire de Rouen, Rouen, France.

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