Đang chuẩn bị liên kết để tải về tài liệu:
Chapter 019. Fever of Unknown Origin (Part 6)

Nosocomial FUO (See also Chap. 125) The primary considerations in diagnosing nosocomial FUO are the underlying susceptibility of the patient coupled with the potential complications of hospitalization. The original surgical or procedural field is the place to begin a directed physical and laboratory examination for abscesses, hematomas, or infected foreign bodies. More than 50% of patients with nosocomial FUO are infected. Intravascular lines, septic phlebitis, and prostheses are all suspect. In this setting, the best approach is to focus on sites where occult infections may be sequestered, such as the sinuses of intubated patients or a prostatic abscess in a. | Chapter 019. Fever of Unknown Origin Part 6 Nosocomial FUO See also Chap. 125 The primary considerations in diagnosing nosocomial FUO are the underlying susceptibility of the patient coupled with the potential complications of hospitalization. The original surgical or procedural field is the place to begin a directed physical and laboratory examination for abscesses hematomas or infected foreign bodies. More than 50 of patients with nosocomial FUO are infected. Intravascular lines septic phlebitis and prostheses are all suspect. In this setting the best approach is to focus on sites where occult infections may be sequestered such as the sinuses of intubated patients or a prostatic abscess in a man with a urinary catheter. Clostridium difficile colitis may be associated with fever and leukocytosis before the onset of diarrhea. In 25 of patients with nosocomial FUO the fever has a noninfectious cause. Among these causes are acalculous cholecystitis deep-vein thrombophlebitis and pulmonary embolism. Drug fever transfusion reactions alcohol drug withdrawal adrenal insufficiency thyroiditis pancreatitis gout and pseudogout are among the many possible causes to consider. As in classic FUO repeated meticulous physical examinations coupled with focused diagnostic techniques are imperative. Multiple blood wound and fluid cultures are mandatory. The pace of diagnostic tests is accelerated and the threshold for procedures CT scans ultrasonography 111In WBC scans noninvasive venous studies is low. Even so 20 of cases of nosocomial FUO may go undiagnosed. Like diagnostic measures therapeutic maneuvers must be swift and decisive as many patients are already critically ill. IV lines must be changed and cultured drugs stopped for 72 h and empirical therapy started if bacteremia is a threat. In many hospital settings empirical antibiotic coverage for nosocomial FUO now includes vancomycin for coverage of methicillin-resistant Staphylococcus aureus as well as broad-spectrum .