Related Experiment Video
Updated: Feb 12, 2026
Stress-induced Antibiotic Susceptibility Testing on a Chip
Published on: January 8, 2014
Antibiotic-induced fever in orthopaedic patients-a diagnostic challenge
Kirsten Labbus1, Jana Karina Junkmann1, Carsten Perka1
1Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Charitéplatz 1, D-10117, Berlin, Germany.
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.
Insights
Antibiotic-induced fever in patients with musculoskeletal infections is often misdiagnosed as a new infection. Promptly recognizing this complication by monitoring for leukopenia and good general condition can prevent unnecessary treatments.
Area of Science:
- Orthopedics
- Infectious Diseases
- Pharmacology
Background:
- Antibiotic-induced fever is an underrecognized complication that can mimic new infections in patients undergoing treatment for musculoskeletal infections.
- Misdiagnosis can lead to prolonged and unnecessary antibiotic courses, increasing healthcare costs and the risk of antimicrobial resistance.
Purpose of the Study:
- To describe the characteristics, diagnostic approach, and outcomes of antibiotic-induced fever in patients treated for musculoskeletal infections.
- To raise awareness among clinicians regarding this potential adverse drug reaction.
Main Methods:
- Retrospective review of patients treated for musculoskeletal infections between 2014 and 2017.
- Diagnosis of antibiotic-induced fever based on specific criteria: temperature >38.0°C, >3 days of intravenous antibiotics, exclusion of other causes, and fever resolution after antibiotic discontinuation.
Main Results:
- Eleven patients (median age 51 years) were included, with fever developing after a median of 20 days of antibiotic therapy.
- Beta-lactam antibiotics were the most common culprits (n=9). Key indicators included leukopenia (n=9) and elevated C-reactive protein (n=10).
- Fever resolved within a median of one day after discontinuing the suspected antibiotic.
Conclusions:
- Antibiotics should be considered a potential cause of fever in orthopedic patients, especially when signs of new infection are absent.
- Key indicators for antibiotic-induced fever include a good general condition despite high temperature and progressive leukopenia.
- Discontinuation or changing the antibiotic leads to rapid fever resolution, avoiding unnecessary diagnostic procedures and treatments.
Related Concept Videos
00:57Antibiotic Selection
01:25Types of Fever
Here are the different types of fever:
01:26Patterns of Fever
01:22Methods of reducing fever
Pharmacological Methods of Reducing Fever:
01:30Development of Antibiotic Resistance
01:29Appendicitis-II: Diagnostic Studies and Management
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...