Saturday night fever: finding and controlling the source of sepsis in critical illness

Fever is a daily concern in the intensive care unit. Although about half of all febrile cases are due to non-infectious causes, fear of sepsis frequently leads to diagnostic tests and escalation of therapy, including broadening antibiotic therapy. Using a case to illustrate this dilemma, we discuss the commonest non-infectious and infectious causes of fever, and suggests approaches to their management. Any unexplained fever in intensive care unit patients warrants investigation, which includes complete clinical assessment and blood cultures. When the source of fever is not immediately apparent, non-infectious and infectious causes should be considered. If stable, non-neutropenic patients should be monitored before further tests or empiric antibiotics are started. In an era of rapid emergence and spread of antimicrobial-resistant pathogens and intense scrutiny of resources, optimal diagnosis and management of patients with suspected infection entails much more than the escalation of antimicrobial therapy.