Prevalence of Bacterial Infection in Febrile Infant 61–90 Days Old Compared With Younger Infants

Bonilla, Leire; Gómez, Borja; Pintos, Carla; Benito, Javier; Mintegi, Santiago

doi:10.1097/inf.0000000000002461

Cited by 32 publications

(48 citation statements)

References 32 publications

(39 reference statements)

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“…There is some controversy about the management of well-appearing patients older than 60 days with a normal urine test result 3,8 . In our sample, the prevalence of bacteremia was similar among patients 29 to 60 days old and among patients 61 to 90 days old, so the same management should be made, and blood tests should be obtained in both age subgroups, as has being recently suggested by Bonilla et al 8 …”

Section: Discussionmentioning

confidence: 51%

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Value of Temperature for Predicting Invasive Bacterial Infection in Febrile Infants

Torre¹,

Gómez

Velasco

2022

Pediatr Emer Care

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Objective: This study aimed to analyze the prevalence of invasive bacterial infection (IBI) among infants younger than 90 days with fever without source according to the degree of fever.Methods: We performed a secondary analysis of a multicenter study with 19 participating Spanish pediatric emergency departments that included 3401 febrile infants 90 days or younger.Results: Prevalence of IBI was 3.2% (5.3% among infants <29 days old, 2.5% among those 29-60 days old, and 2.2% among those 61-90 days old). Prevalence of bacteremia increased with the degree of fever, meanwhile the prevalence of bacterial meningitis did not. No cutoff point was useful for ruling out an IBI safely. Overall, 46.7% of the IBIs were diagnosed in patients with temperature <38.6°(sensitivity, 53.3%; negative likelihood ratio, 0.81). Conclusions:Performing blood tests should be recommended in infants 90 days or younger with temperature ≥38°C without source regardless of the degree of fever.

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Section: Discussionmentioning

confidence: 51%

“…However, we did not find any useful temperature cutoff point for ruling out the presence of an IBI safely. Therefore, urine and blood tests must be performed in infants younger than 90 days with a temperature ≥38°C even if they present a temperature between 38°C and 38.6°C, as it has been showed by prior literature 8,9 …”

Section: Discussionmentioning

confidence: 99%

Value of Temperature for Predicting Invasive Bacterial Infection in Febrile Infants

Torre¹,

Gómez

Velasco

2022

Pediatr Emer Care

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“…[4][5][6][7][8] While rates of bacteremia in infants 61-90 days old may be lower than rates in 0-60 days old infants, data from one recent prospective study suggest that the prevalence of bacteremia even in the third month of life is still high (1%). 26 One study limited to pediatric hospitals found the rate of culture acquisition among febrile infants ≤90 days was 69% for blood and 75% for urine cultures. 16 Our investigation found a low frequency of culture acquisition (27.6% having blood cultures, and 21.3% having urine cultures).…”

Section: Discussionmentioning

confidence: 99%

United States’ Emergency Department Visits for Fever by Young Children 2007-2017

Ramgopal

Aronson

Marín

2020

WestJEM

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Introduction: Our goal in this study was to estimate rates of emergency department (ED) visits for fever by children <2 years of age, and evaluate frequencies of testing and treatment during these visits. Methods: We performed a cross-sectional study of ED encounters from 2007-2017 using the National Hospital Ambulatory Medical Care Survey, a cross-sectional, multi-stage probability sample survey of visits to nonfederal United States EDs. We included encounters with a visit reason of "fever" or recorded fever in the ED. We report demographics and management strategies in two groups: infants ≤90 days in age; and children 91 days to <2 years old. For patients 91 days to <2 years, we compared testing and treatment strategies between general and pediatric EDs using chi-squared tests. Results: Of 1.5 billion encounters over 11 years, 2.1% (95% confidence interval [CI], 1.9-2.2%) were by children <2 years old with fever. Two million encounters (95% CI, 1.7-2.4 million) were by infants ≤90 days, and 28.4 million (95% CI, 25.5-31.4 million) were by children 91 days to <2 years. Among infants ≤90 days, 27.6% (95% CI, 21.1-34.1%) had blood and 21.3% (95% CI, 13.6-29.1%) had urine cultures; 26.8% (95% CI, 20.9-32.7%) were given antibiotics, and 21.1% (95% CI, 15.3-26.9%) were admitted or transferred. Among patients 91 days to <2 years in age, 6.8% (95% CI, 5.8-7.8%) had blood and 7.7% (95% CI 6.1-9.4%) had urine cultures; 40.5% (95% CI, 40.5-40.5%) were given antibiotics, and 4.4% (95% CI, 3.5-5.3%) were admitted or transferred. Patients 91 days to <2 years who were evaluated in general EDs had higher rates of radiography (27.1% vs 15.2%; P<0.01) and antibiotic utilization (42.3% vs 34.2%; P<0.01), but lower rates of urine culture testing (6.4% vs 11.6%, p = 0.03), compared with patients evaluated in pediatric EDs. Conclusion: Approximately 180,000 patients ≤90 days old and 2.6 million patients 91 days to <2 years in age with fever present to US EDs annually. Given existing guidelines, blood and urine culture performance was low for infants ≤90 days old. For children 91 days to <2 years, rates of radiography and antibiotic use were higher in general EDs compared to pediatric EDs. These findings suggest opportunities to improve care among febrile young children in the ED. [West J Emerg Med. 2020;21(6)146-151.] in emergency departments (ED), febrile infants <90 days of age are at risk of serious bacterial infections (SBI), including urinary tract infection (UTI), bacteremia, and meningitis. 3 Therefore,

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“…Young febrile infants with UTI are more prone to have associated bacteraemia 12 . Around 5% of febrile infants <3 months of age with UTI have an associated bacteraemia, with the highest risk in infants <28 days 13 . Traditionally, it has been recommended to hospitalise young febrile infants with suspected UTI due to the concern of acute adverse events and for missing concomitant bacteraemia.…”

Section: Discussionmentioning

confidence: 99%

“…12 Around 5% of febrile infants <3 months of age with UTI have an associated bacteraemia, with the highest risk in infants <28 days. 13 Traditionally, it has been recommended to hospitalise young febrile infants with suspected UTI due to the concern of acute adverse events and for missing concomitant bacteraemia. During the last years, efforts have been made to identify young febrile infants <3 months with suspected UTI at low risk for bacteraemia and suitable for outpatient management.…”

Section: Discussionmentioning

confidence: 99%

Paediatric Escherichia coli bacteraemia presentations and high‐risk factors in the emergency department

et al. 2020

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Aim Escherichia coli (E coli) is a known cause of paediatric bacteraemia. The main objective was to characterise the emergency department (ED) presentations of paediatric E coli bacteraemia and secondarily to identify those related to greater severity. Methods This was a sub‐study of a multicentre cross‐sectional prospective registry including all with E coli bacteraemia episodes between 2011 and 2016. We used multiple correspondence and cluster analysis to identify different patterns. Results We included 291 patients and 43 met criteria for severe disease (14.3%, 95% confidence interval 11.2‐19.3). We identified four types of paediatric E coli bacteraemia presentations. Two (178 patients, 61.2%) were related to well‐appearing previously healthy infants with associated urinary tract infection (UTI). Well‐appearing children older than 12 months old with underlying disease (n = 60, 20.6%) and non‐well‐appearing children of different ages (n = 53, 18.2%) corresponded to the other two types; these had associated UTI infrequently and higher severity rate (15% and 50.9%, respectively, higher when compared with the two previous types, P < .01), including the two patients who died. Conclusion There were four different types of ED paediatric E coli bacteraemia presentations with different severity. Febrile young children with associated UTI showed the best outcome.

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Prevalence of Bacterial Infection in Febrile Infant 61–90 Days Old Compared With Younger Infants

Cited by 32 publications

References 32 publications

Value of Temperature for Predicting Invasive Bacterial Infection in Febrile Infants

Value of Temperature for Predicting Invasive Bacterial Infection in Febrile Infants

United States’ Emergency Department Visits for Fever by Young Children 2007-2017

Paediatric Escherichia coli bacteraemia presentations and high‐risk factors in the emergency department

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