In this issue of CHEST (see page 855), Dr. Paul
Marik presents a clinical approach to fever in critically ill patients.
This concise review reiterates that all fevers are not necessarily
caused by infections and presents a reasonable, albeit not
evidence-based, algorithm for approaching this common clinical problem.
At some hospitals, intensivists and infectious disease physicians may
differ in their general approaches to fever in the ICU. There appears
to be a pervasive notion that intensivists administer antibiotics, and
particularly powerful broad-spectrum antibiotics, more liberally than
infectious disease (ID) experts. I am unaware of any data to support
this contention. Nonetheless, if this is true, and it is reasonable for
each of us who practices critical care medicine to contemplate, we may
be contributing to the problem of multidrug resistance, a modern plague
in the ICU. It is also worthwhile for us to think about why it may be
so (if it is).