Febrile infants: Predictors of bacteremia

Crain, Ellen F.; Shelov, Steven P.

doi:10.1016/s0022-3476(82)80291-6

Cited by 108 publications

(43 citation statements)

References 11 publications

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“…The advantage of CRP over ESR is its rapid rise, less than 24 h from the beginning of an invasive infection [4]. The rise in WBC or ANC may be even more rapid, though not as constant as the rise in CRP [6,23].…”

Section: Discussionmentioning

confidence: 99%

“…In children, serum C-reactive protein (CRP) appears to be more useful than the conventionally used parameters, white blood cell count (WBC) or erythrocyte sedimentation rate (ESR) [4,5]. The absolute neutrophil count (ANC) is usually elevated in bacteraemic infections [6]. An alveolar infiltrate is used as evidence of bacterial, and an interstitial infiltrate as evidence of viral or mycoplasmal pneumonia [7,8].…”

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confidence: 99%

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White blood cells, C-reactive protein and erythrocyte sedimentation rate in pneumococcal pneumonia in children

Korppi

Heiskanen‐Kosma²,

Leinonen³

1997

Eur Respir J

145

109

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White blood cells, C-reactive protein and erythrocyte sedimentation rate in pneumococcal pneumonia in children. M. Korppi, T. Heiskanen-Kosma, M. Leinonen. ©ERS Journals Ltd 1997. ABSTRACT: We evaluated the applicability of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell count (WBC), and absolute neutrophil count (ANC), in the screening of pneumococcal (PNC) pneumonia in children.In 1981-1982, 161 children were treated for radiologically verified communityacquired pneumonia in the hospital during a period of 12 months. The Streptococcus pneumoniae aetiology of infection was studied by antigen, antibody and immune complex assays in acute and convalescent sera. In acute blood samples, CRP was measured by the immunonephelometric method, ESR by the Westergren method, WBC using an automatic cell counter, and thereafter the ANC was calculated after microscopic examination of peripheral smears.CRP and ESR were significantly higher in patients with alveolar (n=53) than in those with interstitial (n=108) pneumonia. CRP, ESR and ANC were significantly higher in PNC (n=29) than in viral (n=23) pneumonia. The values in mixed PNC and viral infections (n=17) were approximately midway between PNC and viral cases. All cases with serologic evidence of S. pneumoniae aetiology were combined (n=46) for calculation of diagnostic parameters. When a cut-off limit of 60 mg·L -1 was used, CRP had a sensitivity of 26% and a specificity of 83% in the screening of PNC pneumonia.We conclude that C-reactive protein and erythrocyte sedimentation rate have a limited capacity to differentiate between pneumococcal and nonpneumococcal pneumonia. C-reactive protein is recommended as the first-line method of screening, and the value of 60 mg·L -1 as the cut-off limit. Eur Respir J 1997; 10: 1125-1129

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

White blood cells, C-reactive protein and erythrocyte sedimentation rate in pneumococcal pneumonia in children

Korppi

Heiskanen‐Kosma²,

Leinonen³

1997

Eur Respir J

145

109

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“…In this group there were 28 positive blood cultures (1.3%; 95% CI: .9 -1.8), 8 positive CSF cultures (.4%; 95% CI: .2-.7), and 165 positive urine cultures (7.6%; 95% CI: 6.5-8.8). Organisms isolated from blood were group B streptococci (12), E coli (9), S pneumoniae (3), S pyogenes (2), Salmonella (1), and Enterobacter cloacae (1). Pathogens isolated from the culture of CSF included group B streptococci (4), E coli (3), and mixed growth of Klebsiella pneumoniae and enterococcus in 1 patient with a bloody sample.…”

Section: Positive Culturesmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8] The patient's physical examination and laboratory evaluation may not detect all SBIs. 9 -19 No definitive data have been reported establishing the timing of detection of positive cultures.…”

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confidence: 99%

Time to Detection of Positive Cultures in 28- to 90-Day-Old Febrile Infants

Kaplan¹,

Harper²,

Baskin³

et al. 2000

Pediatrics

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ABSTRACT. Objective. To determine the time to detection of positive blood, urine, and cerebrospinal fluid (CSF) cultures among febrile 28-to 90-day-old infants.Study Design. Retrospective cohort of consecutive 28-to 90-day-old infants presenting with a temperature of >38°C to an urban pediatric emergency department. Positive cultures and times to detection were noted. Patients were categorized as being at high risk for serious bacterial illness (SBI) based on clinical and laboratory criteria.Results. Of the 3166 febrile infants seen in the emergency department during the study, 2733 had blood (86%), 2517 had urine (80%), and 2361 had CSF (75%) specimens obtained for culture, and 2190 had all 3 cultures (69%) sent. There were 224 positive cultures in 214 patients; of these, 191 had all 3 cultures (89%) sent. Subsequent analyses were confined to those who had all 3 cultures sent. The detected rate of SBI was 8.7% ( Conclusions. The risk of identifying SBI after 24 hours is 1.1% among all 28-to 90-day-old febrile infants and .3% in low-risk infants. Pediatrics 2000;106(6). URL: http://www.pediatrics.org/cgi/content/full/106/6/e74; serious bacterial illness, febrile infants.ABBREVIATIONS. SBI, serious bacterial illness; CSF, cerebrospinal fluid; ED, emergency department; CI, confidence interval; CBC, complete blood cell count. U p to 15% of 28-to 90-day-old febrile infants may have serious bacterial illness (SBI). 1-8 The patient's physical examination and laboratory evaluation may not detect all SBIs. 9 -19 No definitive data have been reported establishing the timing of detection of positive cultures. The practice guidelines by Baraff et al 17 for the management of infants and children 0 to 36 months of age with fever without source include recommendations that were made in the absence of these data. In 2 studies, low-risk infants were treated as outpatients with empiric antibiotics. 9,15 Baskin et al 15 showed that lowrisk febrile infants 28 to 89 days of age can be managed safely with the administration of a parenteral dose of ceftriaxone and discharged from the hospital with a scheduled follow-up within 24 hours for clinical reevaluation and a second dose of ceftriaxone to provide antibiotic coverage while the blood, urine, and cerebrospinal fluid (CSF) cultures incubate. This strategy is based on the assumptions that most pathogens are identified within 48 hours and 2 doses of ceftriaxone will provide sufficient protection for those children whose pathogens are identified later. Other authors, using more stringent risk criteria, advocate outpatient management of low-risk febrile infants without antibiotic treatment, and inpatient management of the rest. 10,18,19 We sought to determine the time to detection of positive cultures so that optimal strategies for management and follow-up can be devised and implemented. METHODS Design, Setting, and SubjectsThe investigation was a retrospective cohort study. Subjects were febrile infants seen in the emergency department (ED) of an urban pediatric teaching hospital. T...

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“…Many of the first recommendations were based on prior reports of occult bacteremia in children, which most often were caused by Streptococcus pneumoniae, Hamophilus influenzae type b, and Neisseria meningitidis, leading to invasive meningitis [1,2]. Early reports focusing on infants in the first 1-3 months of life identified Streptococcus agalactiae (hereafter referred to as Group B Streptococci [GBS]) and enterobacteraceae, especially Escherichia coli and Salmonella spp., as common causes of bacteremia and meningitis [3][4][5]. Due in part to these risks, in the 1970s and early 1980s it was generally recommended that all febrile infants have blood, urine and cerebrospinal fluid (CSF) cultures drawn, receive empiric antibiotics, and be admitted to the hospital pending culture results, though the exact age limit for when this strategy should generally be employed varied widely.…”

Section: Historical Contextmentioning

confidence: 99%