Infants 21-90days presenting with a possible serious bacterial infection - are evaluation algorithms from high income countries applicable in the South African public health sector?

Abstract

BackgroundYoung infants with a possible serious bacterial infection (SBI) are a very common presentation to emergency centres (ECs). It is often difficult to distinguish clinically between self-limiting viral infections and an SBI. Available evaluation algorithms to assist clinicians are mostly from high-income countries. Data to inform clinical practice in low- and middle-income countries are lacking.ObjectivesTo determine the period prevalence of SBI and invasive bacterial infection (IBI) and describe current practice in the assessment and management of young infants aged 21–90 days presenting with a possible SBI to a Paediatric Emergency centre (PEC) in Cape Town, South Africa.MethodsA retrospective cross-sectional review of infants 21–90 days old presenting to the Tygerberg Hospital PED between 1 January 2016 and 31 May 2016.ResultsA total of 248 infants 21–90 days were included in the study. Sixty-two patients (25%, 95% CI 20–30) had an SBI and 13 (5.2%, 95% CI 3–8) had an IBI. One hundred and sixty-five infants had a possible SBI based on WHO IMCI criteria. The sensitivity of the WHO IMCI criteria in detecting SBI was 82.3% (95% CI 70.5–90.8) and the specificity 38.7% (95% CI 31.7–46.1). More than half (51.2%) of the infants received antibiotics within the 48 h prior to presentation, of which 33.5% included intramuscular injection of Ceftriaxone. Only 20 (8.0%) patients in this age group were discharged home after initial evaluation. A significant relationship was noted between fever and the risk of SBI (p-value 0.010) and IBI (p-value 0.009). There also appeared to be a significant relationship between nutritional status and IBI (p-value 0.013).ConclusionPeriod prevalence of SBI and IBI was higher compared to that published in the literature. Validated evaluation algorithms to stratify risk of SBI are needed to assist clinicians in diagnosing and managing infants appropriately in low- and middle-income settings.