Things We Do for No Reason – The “48 Hour Rule‐out” for Well‐Appearing Febrile Infants

OBJECTIVES Initiation and continuation of empirical antimicrobial agents for a 48–72-hour observation period is routine practice in the diagnosis and treatment of infants and children with concern for bacteremia. We examined blood cultures at a freestanding pediatric hospital over a 6-year period to determine the time to positivity. METHODS Data were extracted for all patients who were hospitalized and had blood cultures drawn between January 2013 and December 2018. Time to positivity was calculated on the basis of date and time culture was collected compared with date and time growth was first reported. RESULTS Over a 6-year period, 89 663 blood cultures were obtained, of which 6184 had positive results. After exclusions, a total of 2121 positive blood culture results remained, including 1454 (69%) pathogens and 667 contaminants (31%). For all positive blood culture results, the number and percentage positive at 24, 36, and 48 hours were 1441 of 2121 (68%), 1845 of 2121 (87%) and 1970 of 2121 (93%), respectively. One hundred twenty-five (66 pathogens, 59 contaminants) of the 89 663 cultures (0.14%) yielded positive results between 36 and 48 hours, indicating that 719 patients would need to be treated for 48 hours rather than 36 hours to prevent 1 case of antibiotic termination before positive result. Median times to positive result by pathogen and service line are presented. CONCLUSIONS This study reveals that ≤36 hours may be a sufficient period of observation for infants and children started on empirical antimicrobial agents for concern for bacteremia. These findings highlight opportunities for antimicrobial stewardship to limit antimicrobial .

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Trends and Variation in Length of Stay Among Hospitalized Febrile Infants ≤60 Days Old

Stephens

Hall

Cotter

et al. 2021

Hospital Pediatrics

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OBJECTIVES Researchers in recent studies suggest that hospitalized febrile infants aged ≤60 days may be safely discharged if bacterial cultures are negative after 24–36 hours of incubation. We aimed to describe trends and variation in length of stay (LOS) for hospitalized febrile infants across children’s hospitals. METHODS We conducted a multicenter retrospective cohort study of febrile infants aged ≤60 days hospitalized from 2016 to 2019 at 39 hospitals in the Pediatric Health Information System database. We excluded infants with complex chronic conditions, bacterial infections, lower respiratory tract viral infections, and those who required ICU admission. The primary outcomes were trends in LOS overall and for individual hospitals, adjusted for patient demographics and clinical characteristics. We also evaluated the hospital-level association between LOS and 30-day readmissions. RESULTS We identified 11 868 eligible febrile infant encounters. The adjusted mean LOS for the study cohort decreased from 44.0 hours in 2016 to 41.9 hours in 2019 (P < .001). There was substantial variation in adjusted mean LOS across children’s hospitals, range 33.5–77.9 hours in 2016 and 30.4–100.0 hours in 2019. The change from 2016 to 2019 in adjusted mean LOS across individual hospitals also varied widely (−23.9 to +26.7 hours; median change −1.8 hours, interquartile range: −5.4 to 0.3). There was no association between hospital-level LOS and readmission rates (P = .70). CONCLUSIONS The LOS for hospitalized febrile infants decreased marginally between 2016 and 2019, although overall LOS and change in LOS varied substantially across children’s hospitals. Continued quality improvement efforts are needed to reduce LOS for hospitalized febrile infants.

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Things We Do for No Reason – The “48 Hour Rule‐out” for Well‐Appearing Febrile Infants

Cited by 4 publications

References 30 publications

A Feasibility Study to Attribute Patients to Primary Interns on Inpatient Ward Teams Using Electronic Health Record Data

A Feasibility Study to Attribute Patients to Primary Interns on Inpatient Ward Teams Using Electronic Health Record Data

Time to Blood Culture Positivity by Pathogen and Primary Service

Trends and Variation in Length of Stay Among Hospitalized Febrile Infants ≤60 Days Old

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