Epidemiology of Bacteremia in Febrile Infants Aged 60 Days and Younger

Powell, Elizabeth C.; Mahajan, Prashant; Roosevelt, Genie; Hoyle, John D.; Gattu, Rajender; Cruz, Andrea T.; Rogers, Alexander; Atabaki, Shireen M.; Jaffe, David M.; Casper, T. Charles; Ramilo, Octavio; Kuppermann, Nathan

doi:10.1016/j.annemergmed.2017.07.488

Cited by 76 publications

(58 citation statements)

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“…Two previous investigations reported that, combined, none of 51 afebrile neonates in the first month of life with pustules had an invasive bacterial infection (0%, 95% confidence interval (CI)=0%-7%). 7,8 Adding in the 57 infants with pustules in the current study, none of 108 afebrile infants age 60 days old or younger with pustules had bacteremia or bacterial meningitis (0%, 95% CI = 0-3.4%). Although further studies DOI: 10.1111/pde.13573…”

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confidence: 47%

“…Because neither clinical appearance nor individual laboratory tests can reliably identify serious bacterial infection in infants age 60 days old or younger, febrile infants evaluated in the pediatric emergency department routinely undergo urine, blood, and often cerebrospinal fluid testing, and many are hospitalized on parenteral antibiotic therapy pending bacterial culture results . The operative word that drives this practice is “febrile,” because approximately 10% of these febrile infants have a serious bacterial infection, and 2% have an invasive bacterial infection . The high prevalence of bacterial infection in febrile infants has led clinicians, perhaps reflexively, to manage afebrile infants age 60 days old or younger with skin and soft tissue infections in a similar manner.…”

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confidence: 99%

“…5 The operative word that drives this practice is "febrile," because approximately 10% of these febrile infants have a serious bacterial infection, and 2% have an invasive bacterial infection. 6,7 The high prevalence of bacterial infection in febrile infants has led clinicians, perhaps reflexively, to manage afebrile infants age 60 days old or younger with skin and soft tissue infections in a similar manner. Prior studies have demonstrated that the majortity of these afebrile infants with skin and soft tissue infections undergo extensive testing even though the prevalence of invasive bacterial infection is as low as 0%, [8][9][10] but the small sample sizes of these investigations have resulted in imprecision for these prevalence estimates.…”

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confidence: 99%

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Afebrile neonates with pustules should not be managed as febrile infants

Aronson

2018

Pediatric Dermatology

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Afebrile neonates with pustules should not be managed as febrile infants

Aronson

2018

Pediatric Dermatology

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“…In patients <90 days of age, increased body temperature is a matter of great concern. A fever in these patients requires emergency medical treatment due to the significant risk of serious bacterial infection (SBI) . Several clinical practice guidelines recommend a thorough investigation, including laboratory and blood and urine culture, X‐ray, and rapid viral tests to rule out serious infection SBI in febrile infants.…”

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confidence: 99%

“…A fever in these patients requires emergency medical treatment due to the significant risk of serious bacterial infection (SBI). [1][2][3][4] Several clinical practice guidelines recommend a thorough investigation, including laboratory and blood and urine culture, X-ray, and rapid viral tests to rule out serious infection SBI in febrile infants. Such an exhaustive battery of tests, however, can be expensive.…”

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Predicting serious bacterial infection in febrile young infants utilizing body temperature

Nomura

Ihara

Sakakibara³

et al. 2019

Pediatrics International

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Background Febrile young infants have a high risk of serious infection. Although measuring vital sign parameters can serve as a rapid and effective assessment in these patients, their predictive value for serious bacterial infection (SBI) has not been fully investigated. Methods This retrospective observational study enrolled febrile (>38.0°C) infants aged <90 days at the time of presentation. Data from the emergency room triage database at Tokyo Metropolitan Children's Medical Center for the period 1 November 2011–30 November 2013, were reviewed. Variables included patient age, gender, and vital sign data, including body temperature, pulse rate, oxygen saturation, definitive diagnosis, and disposition. Results Two hundred and sixty‐nine patients were included, with a mean age of 55 days, and 158 (58.7%) were male. Of the total, 43 patients had an SBI. On logistic regression, body temperature ≥38.5°C (OR, 2.80; 95%CI: 1.37–5.74) was a significant predictor of SBI. Conclusion High‐grade fever was found to be a significant predictor of SBI in febrile young infants.

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Prevalence of Bacterial Meningitis Among Febrile Infants Aged 29-60 Days With Positive Urinalysis Results

et al. 2021

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IMPORTANCE Fever in the first months of life remains one of the most common pediatric problems.Urinary tract infections are the most frequent serious bacterial infections in this population. All published guidelines and quality initiatives for febrile young infants recommend lumbar puncture (LP) and cerebrospinal fluid (CSF) testing on the basis of a positive urinalysis result to exclude bacterial meningitis as a cause. For well infants older than 28 days with an abnormal urinalysis result, LP remains controversial.OBJECTIVE To assess the prevalence of bacterial meningitis among febrile infants 29 to 60 days of age with a positive urinalysis result to evaluate whether LP is routinely required.DATA SOURCES MEDLINE and Embase were searched for articles published from January 1, 2000, to July 25, 2018, with deliberate limitation to recent studies. Before analysis, the search was repeated (October 6, 2019) to ensure that new studies were included.STUDY SELECTION Studies that reported on healthy, full-term, well-appearing febrile infants 29 to 60 days of age for whom patient-level data could be ascertained for urinalysis results and meningitis status were included. DATA EXTRACTION AND SYNTHESIS Data were extracted in accordance with Preferred ReportingItems for Systematic Reviews and Meta-analyses (PRISMA) guidelines and used the Newcastle-Ottawa Scale to assess bias. Pooled prevalences and odds ratios (ORs) were estimated using randomeffect models. MAIN OUTCOMES AND MEASURESThe primary outcome was the prevalence of culture-proven bacterial meningitis among infants with positive urinalysis results. The secondary outcome was the prevalence of bacterial meningitis, defined by CSF testing or suggestive history at clinical follow-up. RESULTSThe parent search yielded 3227 records; 48 studies were included (17 distinct data sets of 25 374 infants). The prevalence of culture-proven meningitis was 0.44% (95% CI, 0.25%-0.78%) among 2703 infants with positive urinalysis results compared with 0.50% (95% CI, 0.33%-0.76%) among 10 032 infants with negative urinalysis results (OR, 0.74; 95% CI, 0.39-1.38). The prevalence of bacterial meningitis was 0.25% (95% CI, 0.14%-0.45%) among 4737 infants with meningitis status ascertained by CSF testing or clinical follow-up and 0.28% (95% CI, 0.21%-0.36%) among 20 637 infants with positive and negative urinalysis results (OR, 0.89; 95% CI, 0.48-1.68). CONCLUSIONS AND RELEVANCEIn this systematic review and meta-analysis, the prevalence of bacterial meningitis in well-appearing febrile infants 29 to 60 days of age with positive urinalysis (continued) Key Points Question Are well-appearing febrile infants 29 to 60 days of age with positive urinalysis results at increased risk for bacterial meningitis? Findings In a systematic review and meta-analysis of 17 distinct international data sets (25 374 infants), the pooled prevalence of bacterial meningitis among infants with positive urinalysis results ranged from 0.25% (by cerebrospinal fluid [CSF] cultures or clinical definition) to 0.44% (by CS...

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Epidemiology of Bacteremia in Febrile Infants Aged 60 Days and Younger

Abstract: The prevalence of bacteremia and meningitis among febrile infants 28 days of age and younger is high and exceeds that observed in infants aged 29 to 60 days. E coli and group B streptococcus are the most common bacterial pathogens.

Cited by 76 publications

References 11 publications

Afebrile neonates with pustules should not be managed as febrile infants

Afebrile neonates with pustules should not be managed as febrile infants

Predicting serious bacterial infection in febrile young infants utilizing body temperature

Prevalence of Bacterial Meningitis Among Febrile Infants Aged 29-60 Days With Positive Urinalysis Results

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