Diagnostic markers of acute infections in infants aged 1 week to 3 months: a retrospective cohort study

Abstract

ObjectiveHistory and physical examination do not reliably exclude serious bacterial infections (SBIs) in infants. We examined potential markers of SBI in young febrile infants.DesignWe reviewed white cell count (WBC), absolute neutrophil count (ANC), neutrophil to lymphocyte count ratio (NLR) and C reactive protein (CRP) in infants aged 1 week to 90 days, admitted for fever to one medical centre during 2012–2014.ResultsSBI was detected in 111 (10.6%) of 1039 infants. Median values of all investigated diagnostic markers were significantly higher in infants with than without SBI: WBC (14.4 vs 11.4 K/µL, P<0.001), ANC (5.8 vs 3.7 K/µL, P<0.001), CRP (19 vs 5 mg/L, P <0.001) and NLR (1.2 vs 0.7, P<0.001). Areas under the receiver operating characteristic curve (AUC) for discriminating SBI were: 0.65 (95% CI 0.59 to 0.71), 0.69 (95% CI 0.63 to 0.74), 0.71 (95% CI 0.65 to 0.76) and 0.66 (95% CI 0.60 to 0.71) for WBC, ANC, CRP and NLR, respectively. Logistic regression showed the best discriminative ability for the combination of CRP and ANC, with AUC: 0.73 (95% CI 0.67 to 0.78). For invasive bacterial infection, AUCs were 0.70 (95% CI 0.56 to 0.85), 0.80 (95% CI 0.67 to 0.92), 0.78 (95% CI 0.68 to 0.89) and 0.78 (95% CI 0.66 to 0.90), respectively. CRP combined with NLR or ANC were the best discriminators of infection, AUCs: 0.82 (95% CI 0.70 to 0.95) and 0.82 (95% CI 0.68 to 0.95), respectively.ConclusionsAmong young febrile infants, CRP was the best single discriminatory marker of SBI, and ANC was the best for invasive bacterial infection. ANC and NLR can contribute to evaluating this population.

Neutrophil Lymphocytes Ratio as a Predictor of Bacteremia In Children

“…[21] Several other studies that obtained different results, namely the study by Hamiel U, et al, Obtained CRP results as the best single marker for acute infection in febrile infants, absolute neutrophil count best for invasive bacterial infections and NLR and absolute neutrophils play a role in evaluating bacterial infections. [22] Our research has benets and advantages because we can use NLR as a predictor of bacterial infections as an alternative examination, especially on health facilities that are limited to cheap and simple costs and we can give antibiotics immediately while waiting for the results of blood cultures so that patients can be treated more fast and on target.…”

Social Distancing, Temperature, BCG and the Evolution of COVID-19: A Panel-Model Analysis

“…[17] and [19] categorize the BCG coverage as a binary variable: countries with universal policies of BCG vaccination and countries that never had this program. [13] make a comparison with the number of cases of the disease (per 100 thousand inhabitants) between an Israeli generation that was vaccinated and another that was not. [7] mention mechanisms by which BCG immunization reduces the severity of infections caused by other viruses, from controlled studies.…”

“…To construct this variable, we initially attributed a value of zero to countries that have never had public vaccination policy for BCG (examples: USA and Italy) 12 . Next, for countries that have an active vaccination program (Brazil and China), the historical average percentage of BCG coverage was used 13 . Finally, we consider the countries with a vaccination program that had been interrupted as of some point in time (Australia and a large number of European countries).…”

“…Subtracting this number from 12 http://www.bcgatlas.org. 13 https://www.who.int/data/gho/indicator-metadata-registry/imr-details/2442. 14 An important point in the present study is the incorporation of adequate control variables, or confusion factors: the proportion of elderly people in the population, days after the first case, the capacity of the healthcare system, climate variables and others, all of which are described below.…”

How to predict serious bacterial infections in young febrile infants in the emergency department?

“…When the CRP level is high (>46.1 mg/L), there is a high risk of developing an SBI. 7 However, we must pay attention to some factors that may decline the sensitivity of CRP, such as low birth weight or extremely preterm infants and those with an earlier onset of sepsis. 8 To summarize the above mentioned findings, plasma CRP level could be a good marker for predicting SBIs but not to rule out the early onset of sepsis or guide the empirical choice of antibiotics.…”