Nosocomial Fever in General Medical Wards: A Prospective Cohort Study of Clinical Characteristics and Outcomes

Purpose Nosocomial fever (NF) is a common sign of healthcare-associated infection; however, infection is not always followed up. We studied the etiology, clinical characteristics, and outcomes of nosocomial fever in hospitalized patients. Patients and Methods Between October 2019 and December 2020, we enrolled subjects from general medical wards who developed fever ≥48 hours after hospital admission or who were admitted with fever, defervesced, and then developed a fever ≥7 days later that was unrelated to the cause for admission. Subjects with NF underwent a comprehensive clinical evaluation and laboratory investigations. Results Eighty-six cases of NF were identified and completely followed, the mean age was 69.29 years, and 35 were male. Fifty-seven were from infectious etiologies, 28 from non-infectious etiologies, and one case was unable to be determined. Hospital-associated pneumonia (47.4%) and urinary tract infection (22.8%) were the most common infectious causes, and malignancy (17.8%) and large hematoma (14.3%) were the most common non-infectious causes. The median day of onset of NF following hospitalization was 12 (4.7-21.2) days. Acute physiology and chronic health evaluation II (APACHE II) score (14.70 vs 11.97, p = 0.02), sequential organ failure assessment (SOFA) scores (4 vs 2, p 6 [OR 5.18 (1.04-25.90), p = 0.045], and abnormal chest radiography [OR 3.45 (1.16-10.29), p = 0.026] were significantly associated with mortality. Conclusion Nosocomial infections, malignancy, and hematoma were the leading causes of NF. Severity scores, clinical findings, renal function tests, and chest radiography were distinguishing features between infectious and non-infectious etiologies. ESRD, high SOFA scores, and abnormal chest radiography were associated with mortality.