Objective To conduct a retrospective study about drug-induced hyperthermia (DIH) based on DIH data obtained in medical practice, and elucidate the relationship between DIH incidence and antibacterials overuse. Methods To investigate successively the medical records of inpatients from orthopaedics department in Fudan university affiliated Jinshan hospital at two different periods, and data of DIH cases were extracted to perform a comparative study. The period for 229 effective cases of group Ⅰ was from Feb. 1 to Apr. 30, 2011, before significant improvement on antibacterials use. The period for 342 effective cases of group Ⅱ was from Jul. 1 to Sep. 30, 2012, after the effective enforcements of regulation on antibacterials use. Inclusion criteria for DIH were: ①an oral temperature ≥37.6 ℃ since postoperative day 4, ②no evidence of infection,③a time relationship between fever and the administration of causative drugs: a fever occurring with drug administration and disappearing after drug cessation within 3 days,④no other causes for the fever,⑤oral temperature≤37.6 ℃ until leaving hospital. Exclusion criteria for DIH were listed below: ①possible pathological fever, e.g., in cancer, ②hospitalization within 3 days,③no surgery,④severe trauma, for example, visceral or central nervous system injury. Results All causative drugs were for injection. By comparison, duration of antibacterial administration is significantly shorter in group Ⅱ than in group Ⅰ (1.7±1.7 vs. 4.6±1.8 days, P<0.01), and total DIH incidence and antibacterials related DIH incidence were significantly lower in group Ⅱ than in group Ⅰ (7.3% vs. 30.1%, 1.5% vs. 25.3%, both P<0.01). Conclusion DIH incidence is related with drug type especially with antibacterials overuse, and changed with drug program. DIH was more serious for injection of antibacterials than injection of traditional Chinese medicine. Decrease of antibacterials usage is positively associated with the decreased DIH incidence. Safe medication should begin from safe usage of antibacterials.
Key words:
Antibacterials
;
Hyperthermia,drug-induced
;
Fever,postoperative
;
Antibiotic prophylaxis
;
Injection of traditional Chinese medicine
表1
2组DIH患者病例数、抗菌药物使用持续时间与术后用药数的比较
Tab.1
Comparison DIH cases, the duration of antibacterial dministration and drug number after surgery between two groups of patients ヌ±s
组别
有效病 例数
DIH病 例/例
抗菌药物相 关的DIH 病例/例
术后用 药数/种
抗菌药物 用药的平 均时间/d
Ⅰ组
229
69
58
3.1±1.7
4.6±1.8
Ⅱ组
342
25
5
4.4±1.4
1.7±1.7
χ2 /U
34.07
51.94
1 284.50
180.50
P
<0.01
<0.01
<0.01
<0.01
表1
2组DIH患者病例数、抗菌药物使用持续时间与术后用药数的比较
Tab.1
Comparison DIH cases, the duration of antibacterial dministration and drug number after surgery between two groups of patients ヌ±s
表2
Tab.2
表2
表2
2组DIH患者的抗菌药物用药时间
Tab.2
Time of antibacterial administration in DIH cases between two groups of patients after surgery d,ヌ±s
组别
例数
无植入物手术用药
切开复位加内固定术用药
Ⅰ组
58
4.3±1.4
4.8±1.9
Ⅱ组
5
0
2.0±1.6
All the patients in Group I received antibacterial
Ⅰ组所有患者皆用抗菌药物
表2
2组DIH患者的抗菌药物用药时间
Tab.2
Time of antibacterial administration in DIH cases between two groups of patients after surgery d,ヌ±s
表3
Tab.3
表3
表3
按药物类别的DIH病例数及百分比
Tab.3
Case number of DIH and percentage according drug category
*1Drugs except antibacterial and traditional Chinese medicine injection
*1为除抗菌药物和中药注射剂外的其他药物
表3
按药物类别的DIH病例数及百分比
Tab.3
Case number of DIH and percentage according drug category
表4
Tab.4
表4
表4
各种类可疑药物的DIH病例数
Tab.4
Case count by drug class and each causative drug separately
药物
Ⅰ 组
Ⅱ 组
抗菌药物
58
5
头孢曲松
0
1☆
头孢唑林
3
2(1+1#)
头孢美唑
39(32+7#)
0
头孢替安
6(3+2#+1&)
2
美洛西林/舒巴坦
5(3+2#)
0
头孢西丁
3(2+1#)
0
头孢唑肟
1
0
头孢孟多
1
0
中药注射剂
3
5
丹红
2(1#+1∮)
2(1+1#)
参附
0
3(2+1@)
疏血通
1#
0
其他
24
20
鹿瓜多肽
15(3+10@+1$+1☆)
3(2+1☆)
骨瓜提取物
0
7
骨肽
8(5+2@+1☆)
3(1+1@+1#)
低分子右旋糖酐氨基酸
1
0
七叶皂苷
0
2(1+1#)
蛇毒血凝酶
0
4(3+1#)
托拉塞米
0
1#
总计
85
30
The count is one time in case of fever induced by more than two drugs. The codes of drug combination: ☆=traditional Chinese medicine injection; #=other:drugs except antibacterial and traditional Chinese medicine injection;&=other+traditional Chinese medicine injection;∮= other +antibacterial;@=antibacterial;$= traditional Chinese medicine injection+ antibacterial
CUDDY ML.The effects of drugs on thermoregulation[J].AACN Clin Issues,2004,15(2):238-253.
Body temperature is a balance of the hypothalamic set point, neurotransmitter action, generation of body heat, and dissipation of heat. Drugs affect body temperature by different mechanisms. Antipyretics lower body temperature when the body's thermoregulatory set point has been raised by endogenous or exogenous pyrogens. The use of antipyretics may be unnecessary or may interfere with the body's resistance to , mask an important sign of illness, or cause adverse . Drugs may cause increased body temperature in five ways: altered thermoregulatory mechanisms, drug administration-related fever, fever from the pharmacologic action of the drug, idiosyncratic reactions, and reactions. Certain drugs cause hypothermia by of the thermoregulatory set point or prevention of heat conservation. By affecting the balance of thermoregulatory neurotransmitters, drugs may prevent the signs and symptoms of hot flashes.
MACKOWIAK PA,LEMAISTRE CF.Drug fever:a critical appraisal of conventional concepts:an analysis of 51 episode s in two Dallas hospitals and 97 episodes reported in the English literature[J].Ann Intern Med,1987,106(5):728-733.
Because no systematic analysis of drug fever has been done, there has been no means for testing the validity of published characterizations of this clinical entity. We reviewed the clinical characteristics of 51 episodes of drug fever in 45 patients hospitalized at two Dallas hospitals between 1959 and 1986, and 97 episodes reported in the English literature between 1966 and 1986. Unlike characterizations found in textbooks and review articles, we found relative bradycardia in a minority of cases reviewed; little risk associated with rechallenge unless underlying cardiovascular disease was present; no characteristic fever pattern; a highly variable lag time between the initiation of the offending agent and the onset of fever; an infrequent association with either rash or eosinophilia; and no apparent association of drug fever with systemic lupus erythematosus, atopy, female sex, or advanced age.
FNAGZ,ZENGH,FANGH,et al.Investigation of drug-induced hyperthermia by cefotiam and other antibacterials[J].Chin Pharmaceutical Affairs,2011,25(4):412-415.
Objective Investigate the drug-induced hyperthermia due to cefotiam and other antibacterials in order to promote safe and rational medical treatment.Methods Medical records of 258 in-patients,including 125 cases treated with cefotiam were analyzed,drug-induced hyperthermia due to cefotiam and other medication ws summarized.Results Cefotiam is widely used in China.The patiensts of drug-induced hyperthermia due to cefotiam were 6 cases possible,8 cases affirmed,totally 14 cased,and the rate among patients administrated cefotiam was 11.2%.The total rate of drug-induced hyperthermia among all the patients was 7.8%.Conclusion The package insert should suggest the possible hyperthermia induced by cefotiam in order to keep the safe and rational medical treatment.Considering the poor PK and PD,and its adverse drug reactions of cefotiam,cefotiam must be used as less as possible.
LIME,MOTALLEB-ZADEHR,WALLARDM,et al.Pyrexia after cardiac surgery:natural history and association with infection[J].J Thorac Cardiovasc Surg,2003,126(4):1013-1017.
ABSTRACT Pyrexia is common after major surgery, and infection is often an important consideration. To investigate the natural history and association with infection, we performed a prospective observational study. From November 2000 to January 2001, we studied 219 patients undergoing cardiac surgery screening daily for wound, respiratory, urinary tract, and other infections. Pyrexia was defined as temperature above 37.5 degrees C. Of 219 patients, 7 intraoperative deaths occurred and 1 patient was excluded because of preoperative endocarditis, leaving 211. The mean age (SD) was 64 (10) years, consisting of 172 male patients (81.5%). The proportion pyrexial on days 1, 2, and 5 was 30.0%, 25.8%, and 10.3%, respectively. More patients undergoing urgent or emergency procedures (17.7% versus 7.8%; P =.03) subsequently developed pyrexia. However, there were no differences in wound infection (3.4% versus 8.3%; P =.13), positive cultures for respiratory (14.7% versus 11.4%; P =.16), urinary tract (5.2% versus 2.0%; P =.09), or other infection (8.6% versus 7.3%; P =.71) in patients experiencing postoperative pyrexia compared with those who did not. Pyrexia is common after cardiac surgery and resolves in the majority of patients by day 5. Because there is no association between early pyrexia and infection, diagnosis of early postoperative infection by pyrexia alone is insufficient and is better established by clinical assessment with microbiological evidence.
Abstract Postoperative fever should be evaluated with a focused approach rather than in "shotgun" fashion. Most fevers that develop within the first 48 hours after surgery are benign and self-limiting. However, it is critical that physicians who provide postoperative care be able to recognize the minority of fevers that demand immediate attention, based on the patient's history, a targeted physical examination, and further studies if appropriate. Fever that develops after the first 2 days following surgery is more likely to have an infectious cause, but noninfectious causes that require further evaluation and treatment must also be considered. When evaluating postoperative fever, a helpful mnemonic is the "four Ws": wind (pulmonary causes: pneumonia, aspiration, and pulmonary embolism, but not atelectasis), water (urinary tract infection), wound (surgical site infection), "what did we do?" (iatrogenic causes: drug fever, blood product reaction, infections related to intravenous lines).
FRANK SM,KLUGER MJ,KUNKEL SL.Elevated thermostatic setpoint in postoperative patients[J].Anesthesiology,2003,93(6):1426-1431.
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BURKEL.Postoperative fever:a normal inflammatory response or cause for concern[J].J Am Acad Nurse Pract,2010,22(4):192-197.
Purpose: To devise a systematic diagnostic strategy displayed in algorithm format to assist advanced practice registered nurses (APRNs) in determining when postoperative fever is simply a normal inflammatory response and when further investigation is needed to rule out infection or other serious noninfectious causes of fever.Data sources: Selected research and clinical articles.Conclusions: Postoperative fever is often a normal inflammatory response to surgery, but it can also be a manifestation of a serious underlying infectious or noninfectious etiology. Therefore, it is important to approach each instance of postoperative fever in a systematic manner.Implications for practice: The role of the APRN in managing surgical patients requires being able to accurately assess and evaluate the cause of postoperative fever and take action accordingly. That means taking into account a variety of factors (e.g., patient's medical history, physical examination findings, and type of surgery), so that appropriate diagnostic tests can be ordered to evaluate the cause of the postoperative fever. By being aware of the causes of postoperative fever, the APRN can also take prophylactic action to decrease the risk associated with many of these potential febrile causes.
ANGEL JD,BLASIER RD,ALLISONR.Postoperative fever in pediatric orthopaedic patients[J].J Pediatr Orthop,1994,14(6):799-801.
Abstract Fever in hospitalized patients causes a great deal of concern. Its value in predicting complications, however, is questionable. For this reason, a retrospective analysis was performed on 200 records of children's orthopaedic admissions. Demographic data, would status, fever work-up, and daily peak temperatures were recorded. There were 174 patients who underwent surgical procedures and 26 patients who did not have surgery. Seventy-three percent (127/174) of the surgical patients had postoperative fever [temperature > 38 degrees C (100.4 degrees F)] Twenty-seven percent of the nonsurgical patients had fever. There were only three acute complications--one pneumonia and two wound infections. Complications were easily diagnosed by clinical means. In postoperative patients, the accuracy in predicting complications was 28%. Postoperative fever is a poor predictor of complications, and, therefore, should not delay discharge or indicate investigation for sepsis.
KENANS,LIEBERGALLM,SIMCHENE,et al.Fever following orthopedic operations in children[J].J Pediatr Orthop,1986,6(2):139-142.
One hundred fifty-three orthopedic operations in 129 children were analyzed for the significance of (POF) as a predictive factor for possible complications. In 72% of the operations, a temperature of greater than 37 degrees C was recorded. In 63 operations (41%), the temperature was greater than 38 degrees C. Sixteen children had positive clinical signs that might explain the fever, and all of them had a temperature of greater than 38 degrees C. Duration of operation of greater than 1 h, clubfoot releases, open reduction of fractures, and spine fusion operations gave higher incidences of POF. POF indicates a complication only when associated with positive physical findings. A postoperative temperature of greater than 38 degrees C, therefore, mandates repeated physical examination, which is the most reliable method of discovering the presence of complications.
WALID MS,WOODALL MN,NUTTER JP,et al.Causes and risk factors for postoperative fever in spine surgery patients[J].South Med J,2009,102(3):283-286.
Postoperative fever is a common dilemma faced by neurosurgeons. To study this problem, we prospectively collected patients who developed fever after spine surgery during the academic year 2007-2008 for whom the internist's consultation was requested. Eighty-five (85) patients were identified, of which 17 had an identifiable infectious cause for their febrile reaction (20%) - fever was attributed to urinary tract infection in 8 cases, pneumonia in 5 cases, wound infection in 3 cases (all lumbar), and cholecystitis in 1 case. The remaining 68 patients (80%) had no definitive diagnosis and fever was attributed to a peripheral venous line which, in this case, was replaced or discontinued. In 32 (37.6%) of the patients, the fever developed on postoperative day (POD) 2 or later. There was no statistically significant relationship between day of fever appearance and whether the fever was due to definite infection (P = 0.737). Comparing the basic group with another group of 456 spine surgery patients from 2006-2007 who might or might not have developed fever postoperatively using ANOVA, we found a significant difference in age (P = 0.011) and a very significant difference in hemoglobin level (P = 0.000) and HbA1c level (P = 0.000), but not in body mass index (BMI) (P = 0.289). Thus, most of the postoperative fever cases after spine surgery have no identifiable infectious focus and develop mainly in older patients with anemia and inadequately controlled HbA1c. A meticulous investigation of the source of fever including laboratory and radiological studies remains essential. Early mobilization is recommended for individuals undergoing lower spine surgery in order to decrease bacterial contamination from the gluteal cleavage.
DUANY,WANDS,GUY,et al.Cause analysis and treatment of postoperative fever after clean surgery in orthopaedics[J].Traditional Chin Orthopedics Traumatol,2004,16(2):152-153.
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ANDRES BM,TAUB DD,GURKANI,et al.Postoperative fever after total knee arthroplasty:the role of cytokines[J].Clin Orthop Relat Res,2003 (415):221-231.
Febrile temperatures commonly are seen after total knee arthroplasty, but their source and importance are unclear. The goal of the current study was to determine whether such fevers are part of the normal physiologic response to surgery mediated by inflammatory cytokines. In 20 patients who had total knee arthroplasty, serum and wound drain fluid samples were collected preoperatively and at 1, 6, 24, and 48 hours postoperatively; oral temperatures were measured postoperatively every 4 hours for 3 days. Concentrations of interleukin 1beta, interleukin 6, and tumor necrosis factor alpha in the samples were measured via enzyme-linked immunosorbent assays and compared in patients who did and did not have fevers develop (>or=38.5 degrees C). Gender, age, operative time, amount of blood loss or drain output, anesthesia type, drop in hematocrit, and transfusion administration were not associated with fever. Significant increases were seen postoperatively in drain fluid concentrations of interleukin 1beta and interleukin 6 and in serum concentrations of interleukin 6. Patients who were febrile had significantly higher drain and serum interleukin 6 concentrations than patients who were afebrile. These findings suggest that fevers seen after total knee arthroplasty are at least partly the result of surgical site inflammation and subsequent local and systemic release of the endogenous pyrogen interleukin 6.
SHAW JA,CHUNGR.Febrile response after knee and hip arthroplasty[J].Clin Orthop Relat Res,1999 (367):181-189.
Documentation of the normal fever response after total knee and hip replacement is important to avoid an unnecessary workup for sepsis, and to provide justification for early discharge (dictated by the current medical reimbursement climate) despite persistent postoperative fever. One hundred patients who underwent total knee arthroplasty and 100 patients who underwent total hip arthroplasty were reviewed, several of whom had extensive sepsis workups for evaluation of postoperative fever. No patient in this series had a documented joint infection. All patients were treated with warfarin for deep vein thombrosis prophylaxis. All patients used incentive spirometry and were started on ambulation training on postoperative Day 1. All were given antibiotic prophylaxis for 48 hours. The maximum daily postoperative temperature occurred in most patients on postoperative Day 1 and gradually leveled off toward normal by postoperative Day 5. Only one patient had a maximum temperature on postoperative Day 4 that was greater than that on postoperative Day 3. Patients undergoing revision procedures tended to have a more pronounced febrile response, but the differences were not statistically significant. No significant differences were seen between patients who had epidural anesthesia and patients who had general anesthesia. Seventeen patients had postoperative chest radiographs for evaluation of fever. None had significant atelectasis. The presence of a positive urine culture had no effect on the fever response, with most positive results being identified after the fever had returned toward normal. Postoperative fever after total joint arthroplasty is a normal inflammatory response. A workup for sepsis is not indicated in the perioperative period unless corroborating signs or symptoms are present. Early discharge is appropriate if the febrile response is decreasing progressively.
CUNHA BA.Antibiotic side effects[J].Med Clin North Am,2001,85(1):149-185.
Abstract BACKGROUND: One-week triple therapy is currently regarded as the reference of anti-Helicobacter pylori treatment. However, antibiotic-associated gastrointestinal side effects are among the major pitfalls of such regimens. Probiotic supplementation may be regarded as a therapeutic tool to prevent or reduce these troublesome drug-related manifestations. AIM: To determine whether the addition of the probiotic Lactobacillus GG to an anti-H. pylori standard triple therapy could help to prevent or minimize the occurrence of gastrointestinal side effects. METHODS: One hundred and twenty healthy asymptomatic subjects screened positive for H. pylori infection and deciding to receive eradication therapy were randomized either to 1-week pantoprazole (40 mg b.i.d.), clarithromycin (500 mg b.i.d.), tinidazole (500 mg b.i.d.) or to the same regimen supplemented with Lactobacillus GG for 14 days. Patients filled in validated questionnaires during follow-up to determine the type and severity of side effects and to judge overall tolerability. RESULTS: Bloating, diarrhea and taste disturbances were the most frequent side effects during the eradication week and were significantly reduced in the Lactobacillus GG-supplemented group (RR = 0.4, CI 0.2-0.8; RR = 0.3, CI 0.1-0.8; RR = 0.3, CI 0.1-0.7, respectively). The same pattern was observed throughout the follow-up period. Overall assessment of treatment tolerability showed a significant trend in favor of the Lactobacillus GG-supplemented group (p = 0.03). CONCLUSIONS: Lactobacillus GG supplementation beneficially affects H. pylori therapy-related side effects and overall treatment tolerance. Copyright 2001 S. Karger AG, Basel
VODOVARD,LEBELLERC,MEGARBANEB,et al.Drug fever: a descriptive cohort study from the French national pharmacovigilance database[J].Drug Saf,2012,35(9):759-767.
Although known as a rare adverse drug reaction (ADR), drug fever (DF) remains an important issue in medicine, with the risk of leading to inappropriate and potentially harmful diagnostic and therapeutic interventions. Only sparse data regarding DF have been published.The aim of the study was to investigate which drugs were associated with DF, and report outcomes.Cases of DF without skin reactions were selected from all ADRs reported from 1986 to 2007 in the French National Pharmacovigilance Database. Drugs potentially responsible for DF were assessed using a qualitative case-by-case analysis (Naranjo's criteria) and quantitative measurement (proportional reporting ratio [PRR]). A drug was implicated as the cause of DF when the following criteria were validated: three or more cases and PRR of at least two with a Chi-squared value of at least four.A total of 167 DF cases involving 115 drugs were eligible. Based on the PRR, 22 drugs were significantly associated with DF. Antibacterials represented the most frequently reported drugs, including amikacin (PRR 39.6 [95% CI 23.6, 69.0], oxacillin (9.1 [3.6, 23.4]), cefotaxime (5.5 [2.0, 15.3]), ceftriaxone (5.4 [2.6, 11.3]), rifampicin (4.0 [1.8, 9.2]), vancomycin (4.0 [1.4, 11.5]), ciprofloxacin (3.1 [1.2, 8.0]), isoniazid (3.9 [1.4, 11.4]), pristinamycin (3.1 [1.0, 9.1]) and cotrimoxazole (2.6 [1.2, 5.8]). Median time [interquartile range] from drug administration to fever onset was 2 days [1.0-10.5]. A diagnosis of DF was made following cessation of the suspected drugs (3 days [1.0-11.5] after fever onset. Drug rechallenge was performed (38.0%), resulting in recurrence of DF in all cases. DF resulted in life-threatening events (0.6%), hospitalization or prolonged hospital stay (24.5%) and persistent disability (0.6%). Final outcome was favourable in 96.9% of cases after drug discontinuation.Diagnosing DF is challenging. Based on this large series, antibacterials remain the major class of drugs responsible for DF.
FANGZ,ZHANGK,ZENGH,et al.Study of the safe and rational use of drugs in medical practice under pharmacists’ concern[J].Chin Pharmaceutical Affairs,2010,24(11):1136-1141.
Objective To value the promoting effect on the rational use of drugs and quality of medical practice by clinical pharmacists(CPs)' work-going around the wards and joining in the clinical conference.Methods The two groups were chosen: 55 patients without CPs' concern randomised as group A,and 55 patients under CPs' concern randomised as group B.The days in hospital,total cost,the cost of all drugs,the cost of antibacterials,the days of antibacterial administration,the sorts of antibacterials used of the two groups were counted by the records as charged,which were statistically analysed by t test with SPSS 13.0.So CPs' value was proved.Results Between group A and group B,the days in hospital had no statistical difference(P0.05);the total fees,the cost of all drugs,the cost of antibacterials,the days of antibacterial administration significantly lowered(P0.01).Conclusion The work of CPs in medical practice can promote the rational and safe use of drugs,and can reduce medical cost,and plays an important role on solving the health matters,such as,high medical cost.Laws are needed to support CPs' work.
OHTORIS,INOUEG,KOSHIT,et al.Long-term intravenous administration of antibiotics for lumbar spinal surgery prolongs the duration of hospital stay and time to normalize body temperature after surgery[J].Spine,2008,33(26):2935-2937.
Abstract STUDY DESIGN: Comparative study of differing durations of antibiotics for spinal surgery. OBJECTIVE: To compare rate of infection, duration of hospital stay, days until normal body temperature, and a panel of blood tests after surgery between long-term and short-term administration of antibiotics for spinal surgery using instrumentation. SUMMARY OF BACKGROUND DATA: Recent studies have reported that long-term administration of intravenous antibiotics is not necessary to avoid superficial and deep infections. We therefore changed the duration of administration from 9 to 2 days in our lumbar surgery patients. METHODS: We examined 135 patients (average age, 64.9 years) who underwent lumbar spinal surgery to insert a pedicle screw system to treat spinal canal stenosis. We administered 2 g of cefotiam daily to 60 patients for 9 days after surgery and to 75 patients for 2 days after surgery. Surgical time, loss of blood, rate of infection, duration of hospital stay, days until normal body temperature, and data from blood analysis (white blood cell count, and C-reactive protein [CRP] level) were statistically compared between the 2 groups. RESULTS: No significant differences in intraoperative measures of surgical invasion were observed between the 2 groups (surgical time, 209 vs. 220 minutes; blood loss, 530 vs. 576 mL; blood transfusion, 344 vs. 380 mL for the long-term and short-term groups, respectively). No acute infections occurred in either group. However, the duration of hospital stay (20.7 days), time until normal body temperature (5.1 days), and CRP level (2.23 mg/dL) at day 7 after surgery were significantly less in the short-term group than those in the long-term group (27.9 days, 6.8 days, and 3.13 mg/dL, respectively; P < 0.05). DISCUSSION: These results indicate that short-term intravenous administration of antibiotics did not elevate the infection rate after spinal surgery using instrumentation. However, long-term administration of antibiotics prolonged the duration of hospital stay, inhibited normalization of body temperature, and elevated CRP levels. Long-term administration of antibiotics may suppress normal, beneficial bacteria, thereby having an adverse effect on patient recovery.
HENKERR,CARLSON KK.Fever: applying research to bedside practice[J].AACN Advanced Critical Care,2007,18(1):76-87.
Fever occurs frequently in patients and requires knowledgeable assessment and treatment by critical care nurses. Fever can result from or inflammation and should be differentiated from simple hyperthermia. Although temperature measurement and fever management are not often priorities in the management of a patient, the physiologic consequences of fever may affect patient morbidity. This article defines and describes fever and its pathophysiology. An evidence-based plan of care for the assessment, planning, intervention, and evaluation of the patient with fever is outlined, using levels of recommendation based on the strength of the available evidence. A case study is presented to illustrate application to clinical practice. Commentary about the case is provided to review the salient points of care.
WEIKUNL,JUNJIANK.Investigation on the adverse drug reactions and adverse events of 18 traditional Chinese medical injections by data analysis[J].China Licensed Pharmacist,2011,8(1):4-9.
Objective: To investigate the adverse drug reactions (ADR) and adverse events (ADE) of 18 traditional Chinese medical injections (TCM) by data analysis. To retrieve basic ADR information and research trends related to TCM and to provide evidence for the rational use of TCM, pharmacovigilance and risk management. Methods: To analize the retrieved ADR/ADE of 18 TCMs in Chinese Journals. Results: Among 5 816 cases of ADR/ADE involved in the 18 TCMs, most ADRs/ADEs were related to Ciwujia, Shenmai, Yinzhihuang injections (each of the three injections has more than 900 ADRs, accounting for 74.95% of the tota1). The Ministry of Health and the State Food and Drug Administration (SFDA) have taken measures for the supervision. The four kinds of TCMs (Shuanghuanglian, Ciwujia, Yuxingcao, and Yinzhihuang injections) which were the top 4 reported ADRs/ADEs in literatures were removed from market or suspended for production by part of manufacturers. 5 816 cases of ADRs/ADEs were mostly occur in the age groups of over 40. They usually occurred in the first 30 minutes after taking the drug. The main ADRs reflected as allergic reactions (74.15%). The mortality rate is 0.17%. Conclusion: It is necessary to pay more attention to the ADR, and enforce safety reevaluation of TCM and to promote the clinical rational use.
O'GRADY NP,BARIE P S,BARTLETT J G,et al.Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Diseases Society of America[J].Crit Care Med,2008,36(4):1330-1349.
Abstract OBJECTIVE: To update the practice parameters for the evaluation of adult patients who develop a new fever in the intensive care unit, for the purpose of guiding clinical practice. PARTICIPANTS: A task force of 11 experts in the disciplines related to critical care medicine and infectious diseases was convened from the membership of the Society of Critical Care Medicine and the Infectious Diseases Society of America. Specialties represented included critical care medicine, surgery, internal medicine, infectious diseases, neurology, and laboratory medicine/microbiology. EVIDENCE: The task force members provided personal experience and determined the published literature (MEDLINE articles, textbooks, etc.) from which consensus was obtained. Published literature was reviewed and classified into one of four categories, according to study design and scientific value. CONSENSUS PROCESS: The task force met twice in person, several times by teleconference, and held multiple e-mail discussions during a 2-yr period to identify the pertinent literature and arrive at consensus recommendations. Consideration was given to the relationship between the weight of scientific evidence and the strength of the recommendation. Draft documents were composed and debated by the task force until consensus was reached by nominal group process. CONCLUSIONS: The panel concluded that, because fever can have many infectious and noninfectious etiologies, a new fever in a patient in the intensive care unit should trigger a careful clinical assessment rather than automatic orders for laboratory and radiologic tests. A cost-conscious approach to obtaining cultures and imaging studies should be undertaken if indicated after a clinical evaluation. The goal of such an approach is to determine, in a directed manner, whether infection is present so that additional testing can be avoided and therapeutic decisions can be made.
BENTLEY DW,BRADLEYS,HIGHK,et al.Practice guideline for evaluation of fever and infection in longterm care facilities[J].Clin Infect Dis,2000,31(3):640-653.
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BRATZLER DW,HOUDK PM.Antimicrobial prophylaxis for surgery:an advisory statement from the national surgical infection prevention project[J].Clin Infect Dis,2004,38(12):1706-1715.
In January 2003, leadership of the Medicare National Surgical Infection Prevention Project hosted the Surgical Infection Prevention Guideline Writers Workgroup meeting. The objectives were to review areas of agreement among the published guidelines for surgical antimicrobial prophylaxis, to address inconsistencies, and to discuss issues not currently addressed. The participants included authors from most of the published North American guidelines for antimicrobial prophylaxis and several specialty colleges. The workgroup reviewed currently published guidelines for antimicrobial prophylaxis. Nominal group process was used to draft a consensus paper that was widely circulated for comment. The consensus positions of the workgroup include that infusion of the first antimicrobial dose should begin within 60 minutes before surgical incision and that prophylactic antimicrobial agents should be discontinued within 24 hours of the end of surgery. This advisory statement provides an overview of other issues related to antimicrobial prophylaxis including specific suggestions regarding antimicrobial selection.
MACKOWIAK PA.Drug fever: mechanisms,maxims and misconceptions[J].Am J Med Sci,1987,294(4):275-286.
Although drug fever is a clinical entity that has received considerable attention in textbooks and review articles, only recently have such writings been subjected to critical analysis. In the present review, mechanisms responsible for drug fever are examined. In addition, published characterizations of the syndrome are compared with the results of a recently published systematic analysis of 148 cases of drug fever. This comparison identified a number of important areas in which descriptions of the clinical entity in textbooks and review articles are at odds with the clinical profile exhibited by actual cases of drug fever.
Postoperative fever is a common sequel of spine surgery. In the presence of rigid nationally mandated clinical guidelines, fever management may consume more health care resources than is reasonably appropriate.To study the relationship between postoperative fever, infection rate, and hospital charges in a cohort of spine surgery patients.We retrospectively reviewed 578 spine surgery patients (lumbar microdiskectomy [LMD], anterior cervical decompression and fusion [ACDF], and lumbar decompression and fusion [LDF]). Differences in length of stay and hospital charges as well as risk factors and correlation with infection and readmission rates were studied.Postoperative fever occurred in 41.7% of all spine surgery patients and more often in LDF patients (77.2%). Type of surgery was the most important variable affecting the prevalence of postoperative fever. Significant differences in length of stay were elicited between patients with and without postoperative fever in the ACDF and LMD groups and in hospital cost in the LMD group. The average length of stay was 2.41 vs 4.47 (P .05) in the LDF group. The average hospital charges were $1665261 vs $2265166 (P .05) in the ACDF group, and $5365627 vs $5365210 (P > .05) in the LDF group. Obesity, female sex, and ≥102°F postoperative temperature were the most significant predictors of infection. Delayed discharge referable to postoperative fever did not seem to influence the infection readmission rate.Postoperative fever in spine surgery patients is associated with a delay in patient discharge and increases in hospital charges. Postoperative fever discharge guidelines should be regularly and publicly subjected to appropriate cost-benefit analysis.
CARPENTERJ,SANDERG,NEWBYN,et al.Phenytoin hypersensitivity presenting as postoperative fever[J].Neurosurgery,1980,6(4):426-429.
One of the most catastrophic complications of intracranial surgery is infection. These infections present frequently as postoperative fever and a change in sensorium. Phenytoin is used frequently in conjunction with intracranial operation to prevent seizures. We report two patients in whom, although the full phenytoin sensitivity syndrome ultimately developed, the presenting sign was postoperative fever. The phenytoin sensitivity syndrome is reviewed with emphasis on the fact that all components of the syndrome are not always present initially. The clinical significance of the presentation of phenytoin hypersensitivity as postoperative fever is discussed.
FANGZ,ZENGH,ZHANGJ.One case of clindamycin-induced hyperthermia and the review of drug-induced hyperthermia[J].Clin Med J,2012,10(3):58-60.
The present invention relates to methods of identifying, collecting and isolating pluripotent stem cells, and compositions of purified stem cells for the diagnosis of susceptibility to drug induced myopathy (DIM) and malignant hyperthermia (MH). Specifically, the present invention provides methods of producing skeletal muscle myocytes from patient-specific stem cells, and methods for identifying susceptibility to DIM and MH in patient-specific skeletal muscle myocytes generated from patient-specific stem cells. The present invention also relates to methods, compositions and kits for screening drugs for DIM and MH risk.
Drug fever:a critical appraisal of conventional concepts:an analysis of 51 episode s in two Dallas hospitals and 97 episodes reported in the English literature
Long-term intravenous administration of antibiotics for lumbar spinal surgery prolongs the duration of hospital stay and time to normalize body temperature after surgery
Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Diseases Society of America
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