Top

International Orthopaedics

Published in:

01-08-2018 | Original Paper

Antibiotic-induced fever in orthopaedic patients—a diagnostic challenge

Authors: Kirsten Labbus, Jana Karina Junkmann, Carsten Perka, Andrej Trampuz, Nora Renz

Published in: International Orthopaedics | Issue 8/2018

Abstract

Introduction

Antibiotic-induced fever is a probably underestimated complication, which may be misdiagnosed as new infection. In this study, characteristics, diagnostic approach, and outcome of antibiotic-induced fever in patients treated for musculoskeletal infections are described.

Methods

We retrospectively reviewed all patients with antibiotic-induced fever after surgery treated at our institution from 2014 to 2017. Antibiotic-induced fever was diagnosed, if the following criteria were fulfilled: (i) central (ear) body temperature > 38.0 °C; (ii) intravenous antibiotics for > three days; (iii) exclusion of infectious or other non-infectious causes of fever; and (iv) defervescence after discontinuation of antibiotics.

Results

We included 11 patients (median age 51 years) treated for infection after fracture fixation (n = 5), periprosthetic joint infections (n = 3), infection after spinal instrumentation (n = 1), and soft tissue infection (n = 2). The suspected antibiotics inducing fever were beta-lactam antibiotics (n = 9), vancomycin (n = 3), daptomycin (n = 2), clindamycin, and meropenem (n = 1 each). Additional clinical findings were reduced general condition, generalized exanthema, and rigors, whereas five patients were asymptomatic apart from a fever. Leukopenia was observed in nine patients and increase of C-reactive protein value in ten patients. Fever occurred after a median of 20 days of antibiotic treatment and resolved after a median of one day after discontinuation of the suspected antibiotic.

Conclusions

Antibiotics should be considered as the possible cause of fever in orthopaedic patients receiving antimicrobial treament whenever clinical signs of new or persisting infection are lacking. Important hints suggestive for antibiotic-induced fever are good general condition despite high temperature and progressive leukopenia. Discontinuation or change to another substance leads to prompt defervescence, preventing unnecessary diagnostic procedures and antibiotic treatment.

Badillo AT, Sarani B, Evans SR (2002) Optimizing the use of blood cultures in the febrile postoperative patient. J Am Coll Surg 194(4):477–487 quiz 554-476 CrossRefPubMed

Yoo JH, Restrepo C, Chen AF, Parvizi J (2017) Routine workup of postoperative pyrexia following total joint arthroplasty is only necessary in select circumstances. J Arthroplast 32(2):520–525. https://doi.org/10.1016/j.arth.2016.09.025 CrossRef

Saavedra F, Myburg C, Lanfranconi MB, Urtasun M, De Oca LM, Silberman A, Lambierto A, Gnocchi CA (2008) Postoperative fever in orthopedic and urologic surgery. Medicina (B Aires) 68(1):6–12

Narayan M, Medinilla SP (2013) Fever in the postoperative patient. Emerg Med Clin North Am 31(4):1045–1058. https://doi.org/10.1016/j.emc.2013.07.011 CrossRefPubMed

Burke L (2010) Postoperative fever: a normal inflammatory response or cause for concern. J Am Acad Nurse Pract 22(4):192–197. https://doi.org/10.1111/j.1745-7599.2010.00492.x CrossRefPubMed

Patel RA, Gallagher JC (2010) Drug fever. Pharmacotherapy 30(1):57–69. https://doi.org/10.1592/phco.30.1.57 CrossRefPubMed

Li Z, Shen J, Li Q, Chan MT, Wu WK (2015) Drug fever induced by piperacillin/tazobactam in a scoliosis patient: a case report. Medicine (Baltimore) 94(46):e1875. https://doi.org/10.1097/MD.0000000000001875 CrossRef

Yaita K, Sakai Y, Masunaga K, Watanabe H (2016) A retrospective analysis of drug fever diagnosed during infectious disease consultation. Intern Med 55(6):605–608. https://doi.org/10.2169/internalmedicine.55.5740 CrossRefPubMed

Vodovar D, Le Beller C, Lillo-Le-Louet A, Hanslik T, Megarbane B (2014) [Drug-induced fever: a diagnosis to remember]. Rev Med Interne 35 (3):183–188. doi:https://doi.org/10.1016/j.revmed.2013.02.023

10.

Lipsky BA, Hirschmann JV (1981) Drug fever. JAMA 245(8):851–854CrossRefPubMed

11.

Kim DH, Kim HS, Nam KH, Choi BK, Han IH (2014) Adverse drug reactions of long-term intravenous antibiotics in patients with pyogenic spondylitis. Korean J Spine 11(3):113–116. https://doi.org/10.14245/kjs.2014.11.3.113 CrossRefPubMedPubMedCentral

12.

Olaison L, Belin L, Hogevik H, Alestig K (1999) Incidence of beta-lactam-induced delayed hypersensitivity and neutropenia during treatment of infective endocarditis. Arch Intern Med 159(6):607–615CrossRefPubMed

13.

Oizumi K, Onuma K, Watanabe A, Motomiya M (1989) Clinical study of drug fever induced by parenteral administration of antibiotics. Tohoku J Exp Med 159(1):45–56CrossRefPubMed

14.

Swe T, Ali M, Naing AT (2016) Drug fever induced by piperacillin/tazobactam in an elderly patient with underlying human immunodeficiency virus (HIV) infection. BMJ Case Rep 2016. doi:https://doi.org/10.1136/bcr-2016-215814

Title: Antibiotic-induced fever in orthopaedic patients—a diagnostic challenge
Authors: Kirsten Labbus
Jana Karina Junkmann
Carsten Perka
Andrej Trampuz
Nora Renz
Publication date: 01-08-2018
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 8/2018
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-018-3909-8

At a glance: The STEP trials

Springer Medicine

Antibiotic-induced fever in orthopaedic patients—a diagnostic challenge

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2018

Pelvic reconstructions following peri-acetabular bone tumour resections using a cementless ice-cream cone prosthesis with dual mobility cup

Influence of femoral bowing on range of motion after total hip arthroplasty

Standardized three dimensional computerised tomography scanner reconstructions increase the accuracy of acetabular fracture classification

Intramedullary nailing in opening wedge high tibial osteotomy—in vitro test for validation of a method of fixation

Peri-articular injection of an analgesic mixture in primary total hip arthroplasty: an effective strategy for pain control during the first post-operative day

Jean-Louis Petit (1674–1750): a pioneer anatomist and surgeon and his contribution to orthopaedic surgery and trauma surgery