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 to identify opportunities for reducing antibiotic use in this population. DESIGN: Prospective case series. SETTING: A tertiary-care medical-surgical pediatric intensive care unit (PICU). PATlENTS: Children admitted to the PICU who experienced fever (axillary temperature >38.3 degrees C). MEASUREMENTS: Consecutive children who were febrile at any point in their PICU stay were investigated over two winter seasons. Etiology of the fever was determined by physical examination and routine microbiology and radiographic tests. Three subgroups were reviewed to approximate the number of antibiotic-days that could have been reduced; namely, those with an indeterminate source, those with a documented viral infection, and those receiving a prolonged course of antibiotics. A set of standards reflecting common antibiotic use then was applied to these three patient groups. RESULTS: Of 211 subjects, the majority (83.3%) had either a definitive or suspected focus for their fever, and nearly all of these patients were judged 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 opportunity exists for reduction of antibiotic use. Trials determining the safety of antibiotic reduction in this population should be pursued vigorously.