Bandemia in Children Without a Bacterial Infection

Abstract

BackgroundElevated immature neutrophil percentage (> 5–10 %) or bandemia is used by some clinicians as a sign of serious bacterial infection. In 1991, the Society of Critical Care Management recommended bandemia of greater than 10% should be the criteria for systemic inflammatory response syndrome. Clinicians, since then, have used bands > 10% as an indication of bacterial illness and will often start antibiotics. However, bands can also be elevated in viral infections. We sought to compare the mean band percentage in children with confirmed viral infections to those with bacterial infections.MethodsA retrospective chart review was conducted on children between the ages of ≥ 1 month and ≤ 5 years seen at Winthrop University Hospital’s emergency department from January 1, 2016 through January 1, 2017.We reviewed complete blood counts (CBC) in two groups: Group 1: Febrile children with confirmed viral infection (Diagnosis by FilmArray [multiplex PCR]); Group 2: Febrile children with confirmed bacterial infection (bacteremia, urinary tract infection, meningitis, enteritis). The study was approved by Winthrop IRB.ResultsTable 1:Viral vs. bacterialViralBacterialTotalP-value45642498Age (Months)16.8 (7.4–31.2)7.1 (4.0–26.7)15.9 (6.3–31.0)0.004Duration of Fever (Days)2.0 (1.0–4.0)1.0 (1.0–3.0)2.0 (1.0–4.0)0.061ANC4604 (2844–7834)8638 (4950–11700)4740 (2916–8083)< 0.001WBC Absolute (1000K/uL)11.6 ± 5.716.8 ± 7.512.1 ± 6.0< 0.001Band Proportion3.8 ± 4.73.8 ± 4.83.8 ± 4.70.983Neutrophil Proportion45.6 ± 19.648.5 ± 18.445.9 ± 19.50.367Lymphocyte Proportion39.7 ± 18.636.9 ± 16.239.5 ± 18.40.334Antibiotics Given (N, %)155 (34.0%)39 (92.9%)194 (39.0%)< 0.001Admission to Hospital (N, %)211 (46.3%)26 (61.9%)237 (47.6%)0.055Table 2Bandemia in Viral Infection Bands < 5% Bands ≥ 5% Total P-value 321135456Antibiotics Given (N, %)92 (28.7%)63 (46.7%)155 (34.0%)< 0.001Admission to Hospital (N, %)136 (42.4%)75 (55.6%)211 (46.3%)0.010ConclusionA) We did not find any difference in band proportion between the viral and the bacterial group. B) Children with confirmed viral infection and band proportion > 5% were more likely to get antibiotic and hospital admission.Disclosures All authors: No reported disclosures.