Abstract
BackgroundFever is a cause for concern for both parents and the treating pediatrician and a common reason for antibiotic overuse. However, the proportion of children hospitalized for fever with serious bacterial infection (SBI) is uncertain. We aimed to evaluate the epidemiological, clinical, hematological, and biochemical risks for SBI among the children admitted with fever.MethodThis prospective study was conducted in a rural teaching hospital in India on consecutive children, aged 3 months–12 years, presenting with fever 100 °F (37.7 °C) or higher. The presence of SBI was confirmed with one of the following criteria: (a) a positive blood culture; (b) roentgenographically confirmed pneumonia with high titres of C-reactive protein; (c) a culture-confirmed urinary tract infection; (d) enteric fever diagnosed clinically in addition to either a positive blood culture or high Widal titers; and (e) meningitis diagnosed clinically in addition to either a positive blood culture or cerebrospinal fluid culture. A predefined questionnaire was filled.ResultsA total of 302 children were included in the study, out of which 47% (95% CI 41.4–52.7%) presented with SBI. The factors associated with confirmed SBI in bivariate analysis were history of previous hospitalization, history of chronic illness, history of medication in the previous 1 week, a partially immunized child, history of common cold, moderate-grade fever, toxic look, significant lymphadenopathy, absence of BCG scar, delayed development, irritability, breathlessness, respiratory distress, poor feeding, significant weight loss, suspected urinary tract infection, hyponatremia, hypokalemia, and abnormal leucocyte count. The final generalized logistic regression model revealed partially immunized child (RR 4.26), breathlessness (RR 1.80), weight loss (RR 2.28), and suspected urinary tract infection (RR 1.95) as risk factors for the increased risk of SBI.ConclusionThe study identified multiple risk factors for SBI. Pediatricians can be made aware of these risk factors. Further studies are warranted to identify age-specific risk factors for SBI because most clinicians depend on clinical signs and symptoms to identify SBI.
Highlights
Fever is a cause for concern for both parents and the treating pediatrician and a common reason for antibiotic overuse
The factors associated with confirmed serious bacterial infection (SBI) in bivariate analysis were history of previous hospitalization, history of chronic illness, history of medication in the previous 1 week, a partially immunized child, history of common cold, moderate-grade fever, toxic look, significant lymphadenopathy, absence of BCG scar, delayed development, irritability, breathlessness, respiratory distress, poor feeding, significant weight loss, suspected urinary tract infection, hyponatremia, hypokalemia, and abnormal leucocyte count
Pediatricians can be made aware of these risk factors
Summary
Fever is a cause for concern for both parents and the treating pediatrician and a common reason for antibiotic overuse. The proportion of children hospitalized for fever with serious bacterial infection (SBI) is uncertain. Fever is a common clinical symptom in children and is one of the leading causes for medical consultation and hospital admissions [1]. The underlying infectious disorder causing fever in children can range from mild and self-limiting illness such as upper respiratory tract infection to more serious viral and bacterial illnesses [3]. The diagnosis remains challenging because a wide range of infections can cause fever in a child. The overlapping manifestations of serious bacterial infections (SBIs) with other viral, fungal, parasitic and systemic inflammatory conditions and neoplasms further complicates diagnosis. The overreliance on clinical diagnosis is one of the reasons for irrational use of antibiotics [5]
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