Performance of the Modified Boston and Philadelphia Criteria for Invasive Bacterial Infections

Lyons, Todd W.; Garro, Aris; Cruz, Andrea T.; Freedman, Stephen B.; Okada, Pamela J.; Mahajan, Prashant; Balamuth, Fran; Thompson, Amy D.; Kulik, Dina M.; Uspal, Neil G.; Arms, Joseph; Nigrovic, Lise E.

doi:10.1542/peds.2019-3538

Cited by 20 publications

(3 citation statements)

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“…14,17 However, despite our low rates of testing and antibiotic treatment, only 0.1% of the febrile infants 29–60 days of age who did not receive antibiotics during the initial approach were classified as having a delayed-treated IBI, of which none with bacteremia. Lyons et al 36 in a study on the performance of the modified Boston and Philadelphia criteria in febrile infants 29–60 days found IBI rates of 0.9% and 0.8% among the low-risk classified infants. It is crucial to mention although that in our cohort, the prevalence of bacteremia in the 29–60 days age group was 0.6%, 9 lower than the 1%–2.5% bacteremia prevalence in febrile infants 29–60 days reported from several projects in US PEDs.…”

Section: Discussionmentioning

confidence: 99%

Management and Outcome of Febrile Infants ≤60 days, With Emphasis on Infants ≤21 Days Old, in Swedish Pediatric Emergency Departments

Orfanos

Elfving

Fernandez

et al. 2022

Pediatric Infectious Disease Journal

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Background: Management of febrile infants ≤60 days of age varies, and the age for routine investigations and antibiotic-treatment is debated. The American Academy of Pediatrics recommended age threshold for lumbar puncture (LP) is 21 days and for blood culture 60 days. We describe management and adverse outcome of febrile infants ≤60 days old, in Sweden. Methods: Retrospective cross-sectional study of infants ≤60 days of age with fever without source evaluated in 4 University pediatric emergency departments, between 2014 and 2017. Adverse outcome was defined as delayed-treated invasive bacterial infection (IBI: meningitis or bacteremia). Results: We included 1701 infants. In infants ≤21 days old, LP was performed in 16% (95% CI: 12–20) and blood culture in 43% (95% CI: 38–48). Meningitis was diagnosed in 5 (1.3%; 95% CI: 0.4–3.0) and bacteremia in 12 (4.5%; 95% CI: 2.6–7.0) infants. Broad-spectrum antibiotics were not administered to 66% (95% CI: 61–71), of which 2 (0.8%; 95% CI: 0.1–2.8) diagnosed with IBI (1 meningitis and 1 bacteremia). In the 29–60 days age group, blood culture was performed in 21% (95% CI: 19–24), and broad-spectrum antibiotics were not administered to 84% (95% CI: 82–86), with no case of delayed-treated bacteremia. Conclusions: The rates of LP, blood culture and broad-spectrum antibiotics were low. Despite that, there were few delayed-treated IBIs, but 2 of the 17 infants ≤21 days of age with IBI were not timely treated, which prompts the need for a safer approach for this age group. Also, the utility of routine blood culture for all febrile infants 29–60 days old could be questioned.

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Section: Discussionmentioning

confidence: 99%

Management and Outcome of Febrile Infants ≤60 days, With Emphasis on Infants ≤21 Days Old, in Swedish Pediatric Emergency Departments

Orfanos

Elfving

Fernandez

et al. 2022

Pediatric Infectious Disease Journal

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“… 12 The transition from intrauterine to extrauterine life requires complex physiologic and biochemical changes in the neonatal period, and their disease characteristics could be distinguished from those of patients of other ages. 37 , 38 Third, the algorithm may also help medical decision-making, for example, LP procedure and the avoidance of excessive investigations and medications.…”

Section: Discussionmentioning

confidence: 99%

A Novel Algorithm With Paired Predictive Indexes to Stratify the Risk Levels of Neonates With Invasive Bacterial Infections: A Multicenter Cohort Study

Yin

Chen

Zhong

et al. 2021

Pediatric Infectious Disease Journal

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“…SBI was defined as the presence of meningitis, UTI, or bacteremia, and invasive bacterial infection (IBI) was defined as the presence of meningitis, bacteremic UTI, or bacteremia. Classifications of SBI and IBI were based on the previous reports [9][10][11].…”

Section: Definitionsmentioning

confidence: 99%

The Incidence of Serious/Invasive Bacterial Diseases in Infants 90 Days Old or Younger at an Emergency Hospital in Japan

Yoshitake¹,

Kusama²,

Ito³

et al. 2023

Cureus

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BackgroundThe incidence of severe bacterial infections (SBIs) in infants aged ≤90 days is thought to have decreased because of widespread vaccination programs. However, relevant epidemiological data in Japan are scarce. Materials and methodsThis observational, single-center study investigated the epidemiology of fever in infants aged ≤90 days. SBI was defined as the presence of meningitis, urinary tract infections (UTIs), or bacteremia. Invasive bacterial infection (IBI) was defined as the presence of meningitis, bacteremic UTI, or bacteremia. We determined the incidence of UTIs, bacteremia, meningitis, SBIs, and IBIs in the following three age groups: 0-28, 29-60, and 61-90 days. We subsequently calculated the relative incidence for the groups aged 29-60 and 61-90 days, using the group aged 0-28 days as the reference group. ResultsHerein, 58, 124, and 166 infants were included in the 0-28 days, 29-60 days, and 61-90 days age groups, respectively. Of the total number of patients, 15.5%, 8.9%, and 16.9% in the 0-28 days, 29-60 days, and 61-90 days age groups, respectively, were diagnosed with SBI. The relative incidences were 1 for the 0-28 days group (reference group), 0.67 for the 29-60 days group (95% confidence interval [CI], 0.39-1.15), and 1.08 for the 61-90 days group (95% CI, 0.58-2.00). Of the total number of patients, 10.3%, 3.2%, and 0.6% in the 0-28 days, 29-60 days, and 61-90 days age groups, respectively, were diagnosed with IBI. Relative incidences were 1 (reference group), 0.50 (95% CI, 0.29-0.88), and 0.28 (95% CI, 0.19-0.41) for the 0-28 days, 29-60 days, and 61-90 days age groups, respectively. All cases of IBI were caused by Group B streptococcus (GBS), except for two cases of bacteremia, which were caused by Haemophilus influenzae. ConclusionThe incidence of SBI was similar in the 0-28 days and 61-90 days age groups. However, the incidence of IBI decreased with increasing age. The incidence of UTIs was highest in the 61-90 days age group, and that of meningitis and bacteremia decreased with increasing age.

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Performance of the Modified Boston and Philadelphia Criteria for Invasive Bacterial Infections

Cited by 20 publications

References 50 publications

Management and Outcome of Febrile Infants ≤60 days, With Emphasis on Infants ≤21 Days Old, in Swedish Pediatric Emergency Departments

Management and Outcome of Febrile Infants ≤60 days, With Emphasis on Infants ≤21 Days Old, in Swedish Pediatric Emergency Departments

A Novel Algorithm With Paired Predictive Indexes to Stratify the Risk Levels of Neonates With Invasive Bacterial Infections: A Multicenter Cohort Study

The Incidence of Serious/Invasive Bacterial Diseases in Infants 90 Days Old or Younger at an Emergency Hospital in Japan

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