Abstract
ObjectiveHistorically, management of infants with fever without localizing signs (FWLS) has generated much controversy, with attempts to risk stratify based on several criteria. Advances in medical practice may have altered the epidemiology of serious bacterial infections (SBIs) in this population. We conducted this study to test the hypothesis that the rate of SBIs in this patient population has changed over time.Patients and MethodsWe performed a retrospective review of all infants meeting FWLS criteria at our institution from 1997–2006. We examined all clinical and outcome data and performed statistical analysis of SBI rates and ampicillin resistance rates.Results668 infants met criteria for FWLS. The overall rate of SBIs was 10.8%, with a significant increase from 2002–2006 (52/361, 14.4%) compared to 1997–2001 (20/307, 6.5%) (p = 0.001). This increase was driven by an increase in E. coli urinary tract infections (UTI), particularly in older infants (31–90 days).ConclusionsWe observed a significant increase in E. coli UTI among FWLS infants with high rates of ampicillin resistance. The reasons are likely to be multifactorial, but the results themselves emphasize the need to examine urine in all febrile infants <90days and consider local resistance patterns when choosing empiric antibiotics.
Highlights
The management of infants,90 days with fever without localizing source (FWLS) has been a source of much controversy and debate for the last 30 years
The overall rate of serious bacterial infections (SBIs) was 10.8%, with a significant increase from 2002–2006 (52/ 361, 14.4%) compared to 1997–2001 (20/307, 6.5%) (p = 0.001)
This increase was driven by an increase in E. coli urinary tract infections (UTI), in older infants (31–90 days)
Summary
There were no other significant differences between the early and late period by age group though there was a trend towards increasing bacteremia in the infants aged 0–60d. The six patients with ampicillin resistant gram negative rod bacteremia (1 from the early period, 5 from the later period) all had antibiotics switched when sensitivities were known and all had longer antibiotic courses compared to non-bacteremic infants. Four of those patients stayed at least 2 extra days in the hospital and the other two kept indwelling venous catheters for at least 2 extra days.
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