Abstract
BackgroundTraditional Oriental medicine is used in many Asian countries and involves herbal medicines, acupuncture, moxibustion, and cupping. We investigated the incidence and causes of hospital-acquired fever (HAF) and the characteristics of febrile inpatients in Oriental medical hospitals (OMHs).MethodsPatients hospitalized in two OMHs of a university medical institute in Seoul, Korea, were retrospectively reviewed from 2006 to 2013. Adult patients with HAF were enrolled.ResultsThere were 560 cases of HAF (5.0%). Infection, non-infection, and unknown cause were noted in 331 cases (59.1%), 109 cases (19.5%), and 120 cases (21.4%) of HAF, respectively. Respiratory tract infection was the most common cause (51.2%) of infectious fever, followed by urinary tract infection. Drug fever due to herbal medicine was the most common cause of non-infectious fever (53.1%), followed by procedure-related fever caused by oriental medical procedures. The infection group had higher white blood cell count (WBC) (10,400/mm3 vs. 7000/mm3, p < 0.001) and more frequent history of antibiotic therapy (29.6% vs. 15.1%, p < 0.001). Multivariate analysis showed that older age (odds ratio (OR) 1.67, 95% confidence interval (C.I.) 1.08–2.56, p = 0.020), history of antibiotic therapy (OR 3.17, C.I. 1.85–5.41, p < 0.001), and WBC > 10,000/mm3 (OR 2.22, C.I. 1.85–3.32, p < 0.001) were associated with infection.ConclusionsCompared to previous studies on HAF in Western medicine, the incidence of HAF in OMHs was not high. However, Oriental medical treatment does play some role in HAF. Fever in patients with history of antibiotic therapy, or high WBC was more likely of infectious origin.
Highlights
Traditional Oriental medicine is used in many Asian countries and involves herbal medicines, acupuncture, moxibustion, and cupping
If a patient was transferred from another oriental medical hospital (OMH) where he or she was admitted for more than 48 h and where fever started within 48 h of hospitalization, these fevers were considered hospital-acquired
If a patient was transferred from a medical hospital or long-term care facility and fever had started within 48 h of hospitalization to the OMH, he or she was excluded
Summary
Traditional Oriental medicine is used in many Asian countries and involves herbal medicines, acupuncture, moxibustion, and cupping. We investigated the incidence and causes of hospital-acquired fever (HAF) and the characteristics of febrile inpatients in Oriental medical hospitals (OMHs). Fever is a common clinical event in hospitalized patients. Fever is frequently suspected and proven to be related to infections, diverse etiologies may account for fever in hospitalized patients. Hospital-acquired febrile illness is defined as a fever occurring at least 48 h after hospital admission [1]. The prevalence of hospital-acquired febrile illness has been estimated at 2% to 31% for medical inpatients [2]. There have been studies on the etiologies of fever in elderly patients, solid organ transplant recipients, cancer patients, and neutropenic hosts [3–7]. Fever was attributed to infection in 37% to 74% of patients, whereas a non-infectious etiology was identified in 3% to 52% of patients [1].
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