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The Journal of Cardiovascular Surgery 1998 February;39(1):95-7

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

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


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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.

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