Diagnostic markers of serious bacterial infections in febrile infants younger than 90 days old

Abstract

Background: The aim of this study was to assess correlations between demographic, clinical and laboratory characteristics and the risk of serious bacterial infection (SBI) in febrile <90-day-old infants. Methods: Medical records of all infants younger than 90 days old hospitalized at Dana-Dwek Children 's Hospital (2006's Hospital ( -2008 for evaluation of fever were retrospectively reviewed. Data on clinical, laboratory and demographic characteristics were retrieved and evaluated.Results: Forty-eight of the 401 study infants (12%) had SBI: most of them had urinary tract infection (43 infants; 90% of all SBI), three infants had bacteremia, one had bacterial pneumonia and one had bacterial meningitis. Significant independent clinical predictors for the diagnosis of SBI included duration of fever, absence of rhinitis and the absence of lung and skin manifestations. Significant independent laboratory predictors were absolute neutrophil count (ANC), platelets, blood urea nitrogen and C-reactive protein (CRP) level. On receiver operating characteristic curve analysis, the CRP area under the curve (0.819) was significantly superior to ANC and leukocyte count. Conclusion:Of the clinical and laboratory variables selected for evaluation, qualitative CRP was the strongest independent predictor for diagnosing SBI and a significantly better diagnostic marker than clinical characteristics, ANC and white blood cell count.

Etiology and Causative Pathogens of Febrile Neonates

“…Previous studies on <90 days old babies reported the rate of bacterial meningitis and aseptic meningitisas 0.2% and 14.4%, respectively [25]. In the studies, where only neonates were included, the rate of bacterial meningitis was 0.5-4.4% [2,[11][12][13].…”

“…The combination of procalcitonin with urinalysis was reported as more sensitive for identifying SBI in babies between 2 and 60 days old [28]. Recently, Nosrati reported that CRP was the only parameter found to be significantly associated with SBI (odds ratio, 1.042; 95% confidence interval CI: 1.028-1.056) in febrile infants [25].…”

El valor de proteínas de fase aguda y la prueba LightCycler® SeptiFast en el diagnóstico de infecciones bacterianas y virales en niños

“…[5][6][7] Se ha informado que la proporción de pacientes con aumento de los leucocitos (> 15 x 10/µL) era similar en los pacientes con neumonía bacteriana y viral. 12 Moulin y col. determinaron que la sensibilidad era del 65,1% y la especificidad era del 79,3% respecto del recuento de leucocitos (> 15 x 10/µL) para diferenciar entre la neumonía bacteriana y la viral.…”

“…Los marcadores de fase aguda más frecuentemente utilizados en la práctica clínica son el recuento de leucocitos, el recuento absoluto de neutrófilos, la velocidad de sedimentación globular (VSG), la concentración de proteína C-reactiva y de procalcitonina. [5][6][7] La prueba de reacción en cadena de la polimerasa (PCR) LightCycler ® SeptiFast MGRADE ayuda a detectar microorganismos patógenos en 6 horas, brindando un diagnóstico rápido y temprano de bacteriemia. 8 Se realizó este estudio para investigar el valor de las proteínas de la fase aguda y la prueba LightCycler ® SeptiFast para diferenciar las infecciones bacterianas de las virales.…”

New prediction model for diagnosis of bacterial infection in febrile infants younger than 90 days

“…13,14 Given that there is no consensus on the specific cut-off value for CRP that should be used to distinguish high and low risk of SBI in infants with fever, each author chooses the value to be used. Typically, in studies it varies in the range from 20 to 70 mg/L 19 , provided that for the population up to 90 days old most frequently used value is 20 mg/L 8,11,12,20 . Our cut-off value of 13.3 mg/L is somewhat lower than theirs, but close to the one used in a research by Zarkesh et al 10 , whose diagnostic value of CRP (sensitivity 81.6% and specificity 89.8%) shows results comparable to ours.…”