Composite Bacterial Infection Index in the Evaluation of Bacterial versus Viral Infections in Children: A Single Centre Study

Abstract

Evaluation of febrile infants and children without source possess a great clinical concern as bacteremia is associated with morbidity and mortality in those ages. Differential diagnosis between bacterial and viral infections is of utmost importance for clinicians. Although several biochemical indices steer diagnosis towards bacterial agents, data are often indefinite. Haematological parameters were combined along with established infection indices in a low-cost and easily performed index that could confirm the presence of acute infection and we investigated whether that index could differentiate viral from bacterial infection in febrile infants and children. We studied 69 children with infection and equal number of matched controls, during three years. Bacterial agents were demonstrated in 17 and viral pathogens in 52 patients. Complete blood count with differential, erythrocyte sedimentation rate and C-reactive protein were evaluated and combined into a single formula, constructing an index. Receiver Operating Characteristic curve analysis was performed to evaluate the index discriminating patients from controls as well as patients with bacterial from those with viral infection. Therefore mentioned index value was significantly higher in febrile patients than controls. Bacterial infected patients had significantly higher values than those with viral infection. The composite index not only had high accuracy in discriminating patients from controls, but also in distinguishing bacterial from viral infections. If further and larger studies confirm these observations, the suggested index could be used as a low-cost, rapid and easily performed complementary index, discriminating bacterial from viral infection in the emergency department setting.