Consensus Recommendations

Document Overview

Design and created by Guideline Central in participation with the Infectious Diseases Society of America and Society of Critical Care Medicine.

Evaluating New Fever in Adult Patients in the ICU

Infectious Diseases Society of America

Society of Critical Care Medicine

Publication Date: Oct 12, 2023

Page Last Updated: May 6, 2026

Society of Critical Care Medicine GRADE System

Grade Definitions on Strength of Recommendation and Guide to Interpretation
Strength	Wording in the guideline	For the patient	For the clinician
Strong	"should use" or "should be used"	Most individuals in this situation would want the recommended course and only a small proportion would not.	Most individuals should receive the recommended course of action. Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences.
Conditional	"may be used" or "may consider" or "Y (less preferred drug) may be used instead of X (preferred drug)" or "may consider Y instead of X (preferred drug)"	The majority of individuals in this situation would want the suggested course, but many would not.	Different choices would be appropriate for different patients. Decision aids may be useful in helping individuals in making decisions consistent with their values and preferences. Clinicians should expect to spend more time with patients when working towards a decision.
Good Practice Statement (GPS)
Ungraded Statement (U)

Grade Definitions of Quality and Certainty of the Evidence
Quality Grade	Definition
High	Very confident that the true effect lies close to that of the estimate of the effect.
Moderate	Moderately confident in the effect estimate. The true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different.
Low	Confidence in the estimate is limited. The true effect may be substantially different from the estimate of effect.
Very low	Very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect.

Document Overview

Document Title: Evaluating New Fever in Adult Patients in the ICU

Authoring Societies

Infectious Diseases Society of America

Society of Critical Care Medicine

Document Publication Date: Oct 12, 2023

Page Last Reviewed/Updated: May 6, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: journals.lww.com/ccmjournal/fulltext/2023/11000/society_of_critical_care_medicine_and_the.13.aspx

Source Citation: O’Grady, Naomi P. MD, FCCM, FIDSA¹; Alexander, Earnest PharmD, FCCM²; Alhazzani, Waleed MBBS, MSc, FRCPC³; Alshamsi, Fayez MBBS⁴; Cuellar-Rodriguez, Jennifer MD⁵; Jefferson, Brian K. DNP, ACNP-BC, FCCM⁶; Kalil, Andre C. MD, MPH, FCCM, FIDSA⁷; Pastores, Stephen M. MD, MACP, FCCP, FCCM⁸; Patel, Robin MD, FIDSA, FRCPC^9,10; van Duin, David MD, PhD, FIDSA¹¹; Weber, David J. MD, FIDSA, FSHEA, FRSM, FAST¹¹; Deresinski, Stanley MD, FIDSA¹². Society of Critical Care Medicine and the Infectious Diseases Society of America Guidelines for Evaluating New Fever in Adult Patients in the ICU. Critical Care Medicine 51(11):p 1570-1586, November 2023. | DOI: 10.1097/CCM.0000000000006022

Document Scope, Criteria, and Use Cases

Document Objectives: The guidelines panel was able to formulate several recommendations for the evaluation of new fever in a critically ill adult patient, acknowledging that most recommendations were based on weak evidence. This highlights the need for the rapid advancement of research in all aspects of this issue—including better noninvasive methods to measure core body temperature, the use of diagnostic imaging, advances in microbiology including molecular testing, and the use of biomarkers.

Scope: Assessment and Screening, Diagnosis

Diseases/Conditions (MeSH)

D003422 - Critical Care

D005334 - Fever

D016638 - Critical Illness

D007362 - Intensive Care Units

D003422 - Critical Care

D005334 - Fever

D016638 - Critical Illness

D007362 - Intensive Care Units

Keywords: ICU, critically ill, fever, intensive care, intensive care unit

Target Patient Population: Critically ill adult patients in the hospital or ICU presenting with new fever

Target Provider Population: Critical care, infectious diseases, clinical microbiology, organ transplantation, public health, clinical research, and health policy and administration

Inclusion Criteria: Male, Female, Adult, Older Adult

Health Care Settings: Emergency Care, Hospital

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Supplemental Methodology Resource: Data Supplement

Number of Source Documents: 112

Literature Search End Date: Wednesday, June 29, 2022

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Identifies study selection process?: Yes

Identifies study selection criteria?: Yes

Identifies methods used to evaluate and analyze the evidence?: Yes

Identifies key questions addressed by the systematic review?: Yes

Identifies search strategy?: Yes