Epidemiology of Bacteremia in Previously Healthy Febrile Infants: A Follow-up Study

Abstract

OBJECTIVE: Describe the etiology of bacteremia among a geographically diverse sample of previously well infants with fever admitted for general pediatric care and to characterize demographic and clinical characteristics of infants with bacteremia according to bacterial etiology. We hypothesized that the epidemiology of bacteremia in febrile infants from a geographically diverse cohort would show similar results to smaller or single-center cohorts previously reported. METHODS:This was a retrospective review of positive, pathogenic blood cultures in previously healthy, febrile infants ≤90 days old admitted to a general unit. In total, there were 17 participating sites from diverse geographic regions of the United States. Cultures were included if the results were positive for bacteria, obtained from an infant 90 days old or younger with a temperature ≥38.0°C, analyzed using an automated detection system, and treated as pathogenic. RESULTS:Escherichia coli was the most prevalent species, followed by group B Streptococcus, Streptococcus viridans, and Staphylococcus aureus. Among the most prevalent bacteria, there was no association between gender and species (Ps > .05). Age at presentation was associated only with Streptococcus pneumoniae. There were no cases of Listeria monocytogenes. CONCLUSIONS:Our study confi rms the data from smaller or single-center studies and suggests that the management of febrile well-appearing infants should change to refl ect the current epidemiology of bacteremia. Further research is needed into the role of lumbar puncture, as well as the role of Listeria and Enterococcus species in infantile bacteremia.

Reducing Variability in the Infant Sepsis Evaluation (REVISE): A National Quality Initiative

“…Appropriate Antibiotic Use This measure was defined as the percentage of infants who received recommended empirical antibiotic regimens within 24 hours of presentation. [18][19][20] Recommended antibiotics were considered to be (alone or in combination) none administered, ampicillin, aminoglycosides, or third-generation cephalosporins. All other antibiotics or combinations of antibiotics were considered inappropriate.…”

Empiric Antibiotic Use and Susceptibility in Infants With Bacterial Infections: A Multicenter Retrospective Cohort Study

“…Little is known about geographic differences in the epidemiology of these organisms in infants, although recent studies suggest that L monocytogenes infections are increasingly rare. 9,10 Fostering judicious use of antibiotics has been identified as a priority in the United States as a means to limit the spread of antibiotic resistance, medical complications, caregiver stress, and costs. 11,12 The main objective of this study was to describe empirical antibiotic use, bacterial epidemiology, and antibiotic susceptibility patterns for the most common pathogens in infants ,90 days old with confirmed bacterial infection across 8 regionally diverse US children's hospitals.…”

Is Tradition Trumping Evidence in the Treatment of Young, Febrile Infants?

“…1,2 However, recent evidence suggests that the modern epidemiology for bacteremia has shifted. 3,4 E. coli has now surpassed GBS, and in multiple reports Listeria has gone from rare to exceedingly rare or nonexistent (a decrease that may be explained by enhanced regulation around food safety or a "collateral benefit" of GBS screening and prophylaxis). 5 Nonetheless, ampicillin is still included in most current empiric regimens, presumably to cover for Listeria or Enterococcus.…”