Intramuscular versus oral antibiotic therapy for the prevention of meningitis and other bacterial sequelae in young, febrile children at risk for occult bacteremia

Fleisher, Gary; Rosenberg, Norman; Vinci, Robert J.; Steinberg, Joel; Powell, Keith P; Christy, Cynthia; Boenning, Douglas A.; Overturf, Gary D.; Jaffe, David M.; Platt, Richard

doi:10.1016/s0022-3476(05)83126-9

“…Estudos dos anos 80 e 90 constataram que as crianças de até 3 anos com FSSL, contagem de leucócitos > 15.000/mm 3 e temperatura > 39 ºC tinham risco de IBG 7,[12][13][14] . Em 1992, Baraff & Lee 12 estimaram em 13% o risco de BO em pacientes com contagem de leucócitos ≥ 15.000/mm 3 .…”

Section: Introductionunclassified

Fever without source: evaluation of a guideline

Machado¹,

Cardoso²,

Paulis³

et al. 2009

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Objective: To evaluate the applicability of a standardized guideline for children up to 36 months of age with fever without source (FWS). Methods:Prospective cohort study involving children with FWS treated at the emergency department of Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil, from June 2006 to May 2007. The guideline classifies the risk of serious bacterial infection (SBI) according to the presence or absence of toxemia, age, and temperature. Laboratory screening was based on risk assessment: complete blood count, blood culture, urinalysis, urine culture, and, if necessary, chest radiography, cerebrospinal fluid, and coproculture. Results:We studied 251 children and, of these, 215 were followed up until the final diagnosis. Toxemia was found in 20 children, and 195 were well-appearing (30 up to 3 months old and 165 from 3 to 36 months old). Among those children from 3 to 36 months without toxemia, 95 had axillary temperature > 39 ºC. In 107 (49.8%) children, there was spontaneous resolution of fever; in 88 (40.9%), benign self-limited disease was identified; and in 20 (9.3%), there was SBI. Among the cases of SBI, we identified 16 urinary tract infections, three cases of pneumonia and one occult bacteremia. Of the 215 children, 129 (60%) received no antibiotics, and 86 received antibiotics at some point (45 empirically). Empirical antibiotic treatment was maintained for an average of 72 hours. Conclusion:The guideline was shown to be appropriate to follow up these children using simple laboratory tests that can be carried out at most health facilities. The most frequent SBI in this sample was urinary tract infection. J Pediatr (Rio J)

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“…Among the 6649 nontoxic-appearing children 3 to 36 months of age with temperatures of 39°C or higher evaluated as outpatients in the occult bacteremia database, only 2 (0.03%; 95% CI, 0.004 -0.1%) had meningococcal bacteremia. 13 The peripheral blood smears of those two children had 18% and 1% bands. In the same database, 1541 of the 5347 (29%) culture-negative patients who had peripheral blood smears performed had 10% or greater bands.…”

Section: Predictive Value Of the Band Countmentioning

confidence: 91%

“…These patients were enrolled in a study of occult bacteremia at 10 medical centers from 1987 to 1991 (occult bacteremia database). 13 In that study, 6649 nontoxic-appearing children, 3 to 36 months old, with temperatures of 39°C or higher with no apparent bacterial foci of infection (other than otitis media) had blood cultures drawn and were discharged to home. Children with nonspecific signs of viral illnesses including diarrhea/vomiting and wheezing were not excluded; 6414 of the 6649 children had negative blood cultures and comprised our comparison group.…”

Section: Patients With Negative Blood Cultures From the Occult Bactermentioning

confidence: 99%

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Clinical and Hematologic Features Do Not Reliably Identify Children With Unsuspected Meningococcal Disease

Kuppermann

¹

,

Malley

²

,

Inkelis

³

et al. 1999

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ABSTRACT. Objective. To determine the frequency of unsuspected meningococcal disease (UMD) in young febrile children with meningococcal infections and evaluate whether clinical and laboratory parameters commonly used in the evaluation of fever can help identify children with UMD.Methods. We reviewed the records of children with meningococcal disease from 1985 to 1996 at four referral centers. Children who were evaluated as outpatients and then discharged to home, from whom Neisseria meningitidis was isolated from blood or cerebrospinal fluid cultures obtained during these outpatient visits, were considered to have UMD. We compared clinical and laboratory parameters between these children and 6414 febrile outpatients 3 to 36 months old with negative blood cultures enrolled in a separate study of occult bacteremia.Results. We identified 381 children with meningococcal disease, of whom 45 (12%) had UMD. Of the 45 with UMD, 37 (82%) were 3 to 36 months old. Compared with the 6414 culture-negative patients, these 37 patients with UMD were significantly younger (8.9 ؎ 5.4 vs 14.2 ؎ 8.1 months) and had significantly higher band counts (14.3 ؎ 11.1 vs 7.3 ؎ 7.5%). There were no significant differences, however, in temperature, white blood cell counts, and absolute neutrophil counts. Multivariate analysis identified young age and the band count as independent predictors of UMD.Conclusions. Children ultimately diagnosed with meningococcal disease have commonly been evaluated as outpatients and discharged to home before diagnosis. Of the hematologic parameters frequently used in the evaluation of fever, only the band count differs significantly between young febrile children with UMD and those with negative cultures. Because UMD is uncommon in young febrile pediatric outpatients, however, the predictive value of the band count is low. Thus, the complete blood count is not routinely helpful for the diagnosis of UMD. Pediatrics 1999;103(2). URL: http://www. pediatrics.org/cgi/content/full/103/2/e20; Neisseria meningitidis, meningococcal infections, bacteremia, complete blood count, neutrophil.

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“…10,11 Studies carried out in the 1980s and 1990s have found that children aged up to 3 years who had FWS, white blood cell count (WBC) > 15,000/mm 3 and temperature > 39 ºC were at risk of having SBI. 7,[12][13][14] In 1992, Baraff & Lee 12 estimated a 13% risk of OB in patients with WBC ≥ 15,000/mm 3 .…”

Section: Introductionmentioning

confidence: 99%

Febre sem sinais localizatórios: avaliação de um protocolo de atendimento

Machado¹,

Cardoso²,

Paulis³

et al. 2009

J. Pediatr. (Rio J.)

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Objective: To evaluate the applicability of a standardized guideline for children up to 36 months of age with fever without source (FWS). Methods:Prospective cohort study involving children with FWS treated at the emergency department of Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil, from June 2006 to May 2007. The guideline classifies the risk of serious bacterial infection (SBI) according to the presence or absence of toxemia, age, and temperature. Laboratory screening was based on risk assessment: complete blood count, blood culture, urinalysis, urine culture, and, if necessary, chest radiography, cerebrospinal fluid, and coproculture. Results:We studied 251 children and, of these, 215 were followed up until the final diagnosis. Toxemia was found in 20 children, and 195 were well-appearing (30 up to 3 months old and 165 from 3 to 36 months old). Among those children from 3 to 36 months without toxemia, 95 had axillary temperature > 39 ºC. In 107 (49.8%) children, there was spontaneous resolution of fever; in 88 (40.9%), benign self-limited disease was identified; and in 20 (9.3%), there was SBI. Among the cases of SBI, we identified 16 urinary tract infections, three cases of pneumonia and one occult bacteremia. Of the 215 children, 129 (60%) received no antibiotics, and 86 received antibiotics at some point (45 empirically). Empirical antibiotic treatment was maintained for an average of 72 hours. Conclusion:The guideline was shown to be appropriate to follow up these children using simple laboratory tests that can be carried out at most health facilities. The most frequent SBI in this sample was urinary tract infection.J Pediatr (Rio J). 2009;85(5):426-432: Fever without source, children, serious bacterial infection.

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Intramuscular versus oral antibiotic therapy for the prevention of meningitis and other bacterial sequelae in young, febrile children at risk for occult bacteremia

Cited by 124 publications

References 27 publications

Fever without source: evaluation of a guideline

Fever without source: evaluation of a guideline

Clinical and Hematologic Features Do Not Reliably Identify Children With Unsuspected Meningococcal Disease

Febre sem sinais localizatórios: avaliação de um protocolo de atendimento

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