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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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ORIGINAL ARTICLES CARDIAC PAPERS
The Journal of Cardiovascular Surgery 1998 February;39(1):95-7
Management of postoperative fever in cardiovascular surgery
Ishikawa S., Ohtaki A., Takahashi T., Sato Y., Koyano T., Hasegawa Y., Yamagishi T., Ogino T., Ohki S., Kamiyushihara M., Morishita Y.
From the Second Department of Surgery, Gunma University School of Medicine,Maebashi, Japan
Background. The causes and management of postoperative fever were studied.
Materials and methods. During a four -year -period beginning in January of 1991, high fever over 38.5°C max occurred in twenty-five (6%) out of 395 patients who underwent cardiovascular surgery.
Results. Nine of the patients (28%) evidenced bacteriological infections as follows; 3 cases of mediastinitis, 2 cases of respiratory tract infection, 1 case of MRSA colitis and a wound infection in one case. The three patients with mediastinitis died and the two cases of MRSA were detected from the culture of pacemaker leads. Bacterio-logical infection was not detected in other 18 (72%) patients with fever. However, we speculated that the clinical causes of fever in 9 out of 18 patients were as follows; catheter fever in 3 patients, acalculous cholecystitis in 2, fungus infection in 2, aseptic meningitis in one and viral myelitis in one patient. Two patients with acalculous cholecystitis recovered after percutaneous transhepatic gallbladder drainage. The causes of fever were not apparent in nine patients, however the source might be related to artificial prostheses used intraoperatively in five patients. C-reactive protein (CRP) was elevated beyond 10 mg/dl in 13 (52%) of the 25 patients. CRP increased in all seven bacteriologically positive patients and in six (32%) of the bacteriologically negative patients.
Conclusions. Precise and prompt bacterial examinations are necessary in patients with CRP elevation because the origins of fever were bacteriological in only 28% of the patients with a high fever. Good prognoses may be obtained by suitable management in bacteriologically negative patients.