Invasive Bacterial Infections In Infants Research Articles

Severe and invasive bacterial infections in infants aged less than 90 days with and without SARS-CoV-2 infection

BackgroundFever in children represents one of the most common causes of medical evaluation. Infants younger than 90 days of age are at higher risk of severe and invasive bacterial infections (SBI and IBI). However, clinical signs and symptoms of viral and bacterial infections in young infants are frequently similar, and several studies have shown that the risk of SBIs remains non-negligible even in the presence of a positive point-of-care viral test. Our study aims to evaluate whether the proportion of SBIs and IBIs in febrile infants younger than 90 days during the COVID-19 pandemic was higher than that in the pre-pandemic period, and to describe the proportion of SBIs and IBIs in infants with and without SARS-CoV-2 infection.MethodsThis was a retrospective single-center cohort study conducted at the Children's Hospital of the University of Padua in Italy, involving febrile young infants evaluated in the Pediatric Emergency Department (PED) and admitted to Pediatric Acute Care Unit (PACU) between March 2017 to December 2022. Infants admitted before the COVID-19 pandemic were compared to infants admitted during the pandemic period and SARS-CoV-2 positive patients to the negative ones.Results442 febrile infants younger than 90 days were evaluated in Padua PED and admitted to the wards. The proportion of SBIs and IBIS did not significantly change over the study periods, ranging between 10.8% and 32.6% (p = 0.117) and between 0% and 7.6%, respectively (p = 0.367). The proportion of infants with a diagnosis of SBIs and IBIs was higher in the SARS-CoV-2 negative group (30.3% and 8.2%, respectively) compared to the positive group (8.5% and 2.8%, respectively) (p < 0.0001). The most common diagnosis in both groups was UTI, mainly caused by E. coli. A similar proportion of blood and urine cultures were performed, whereas lumbar puncture was more frequently performed in SARS-CoV-2 negative infants (40.2% vs 16.9%, p = 0.001).ConclusionsAlthough the risk of concomitant serious bacterial infection with SARS-CoV-2 is low, it remains non-negligible. Therefore, even in SARS-CoV-2-positive febrile infants, we suggest that the approach to screening for SBIs remains cautious.

Incidence of infant Gram-negative invasive bacterial infections in England, 2011–2019: an observational study using population-wide surveillance data

ObjectiveInvasive bacterial infections account for an estimated 15% of infant deaths worldwide. We aimed to estimate the incidence and trends in invasive bacterial infections in infants caused by Gram-negative pathogens...

Invasive Bacterial Infections in Infants With Skin and Soft-Tissue Infections

Research Article| September 01 2021 Invasive Bacterial Infections in Infants With Skin and Soft-Tissue Infections AAP Grand Rounds (2021) 46 (3): 27. https://doi.org/10.1542/gr.46-3-27 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Invasive Bacterial Infections in Infants With Skin and Soft-Tissue Infections. AAP Grand Rounds September 2021; 46 (3): 27. https://doi.org/10.1542/gr.46-3-27 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: bacterial infections, skin, skin and soft tissue infections, soft tissue infections, urinary tract infections, bacteremia Source: Lopez MA, Hall M, et al. Invasive bacterial infections in infants younger than 60 days with skin and soft tissue infections. Pediatr Emerg Care. 2021;37(6):e301-e306; doi: https://doi.org/10.1097/PEC.0000000000001584Google Scholar Investigators from multiple institutions conducted a retrospective cohort study to determine the frequency of invasive bacterial infection (IBI) in infants with skin and soft-tissue infections (SSTI). Infants were eligible if they were: (a) <60 days of age; (b) visited 1 of 35 EDs that contribute data to the Pediatric Health Information System (PHIS) between 2009–2014; and (c) were assigned a primary ICD-9 code for SSTI (eg, cellulitis, abscess, mastitis) or a secondary diagnosis of SSTI and a primary diagnosis of fever, IBI, urinary tract infection (UTI), or anal fistula. Infants with complex chronic conditions were excluded. Demographics as well as... You do not currently have access to this content.

A positive nitrite test was an independent risk factor for invasive bacterial infections in infants under 90days of age with fever without source.

This study analysed the association between a positive nitrite dipstick test and an invasive bacterial infection (IBI) in infants younger than 90days of age with fever without source (FWS). We performed a secondary analysis of data from a prospective multicentre study of infants up to 90days of age with FWS undergoing care in 19 paediatric EDs between October 2011 and September 2013. Invasive bacterial infection was defined as a positive blood or cerebrospinal fluid culture. The dipstick urinalysis was positive for nitrite or leucocyte esterase in 766 (22.5%) of the 3401 infants we studied, and 270 (35.2%) had a dipstick test that was just positive for nitrite. Overall, 107 were diagnosed with an IBI (3.1%). The IBI prevalence was 2.2% among patients with a normal urine dipstick, 4.4% if they had positive leucocyte esterase test results, 8.3% where the nitrite test was positive and 10.6% when both tests were positive. After multivariate analysis, a positive nitrite test remained an independent risk factor for IBI (odds ratio 2.7, 95% confidence interval 1.4-4.9). In infants under 90days of age with FWS, a positive nitrite urine dipstick test was an independent risk factor for IBI.

2328. Community-Onset Invasive Bacterial Infections in Infants Under 3 Months–10 Years of Experience in Auckland, New Zealand

BackgroundSerious infections remain the leading cause of death in the first year of life. Sepsis in neonatal intensive care units is well described but infants with bacterial infections presenting from the community has not previously been described in New Zealand. Recent studies suggest an increasing incidence of Staphylococcus aureus and Streptococcus pyogenes in New Zealand pediatric populations. It is, therefore, important to understand the unique pattern of infections seen in the infant population in New Zealand as this may impact on empiric management.MethodsA retrospective study (2007–2017) including infants aged 8 to 90 days presenting with clinically significant infection and positive culture from a sterile site. Cases were identified from laboratory database and ICD discharge codes, enabling data collection and analysis.Results192 cases were identified from two major hospitals in Auckland. This represented an incidence of invasive bacterial infections of 129/100,000 live births. Escherichia coli (40%) and Streptococcus agalactiae (22%) were the commonest pathogens. Streptococcus pyogenes and Staphylococcus aureus caused 14% and 12% of bacteremias respectively. Pacific island infants had the highest rates of infection (255/100,000) as did those from deprived backgrounds.Conclusion Escherichia coli and Streptococcus agalactiae are the commonest causative organisms in community-onset infant sepsis in Auckland.Rates of invasive bacterial infections in this age group are higher than reported in other industrialized countries (including published data from the USA), with Staphylococcus aureus and Streptococcus pyogenes being the most disproportionate. Our study demonstrates the increased risk of invasive Staphylococcus aureus and Streptococcus pyogenes in New Zealand, even at this early age, and this impacts on empiric antibiotic prescribing and management of infant sepsis in New Zealand. The risk of invasive infection is highest in Pacific and Māori infants and those from deprived backgrounds.A small number of multi-resistant organisms were present in this age group, prior to antibiotic exposure, illustrating that rising rates of community antimicrobial resistance will need to be considered even when prescribing for infants.Disclosures All authors: No reported disclosures.

Modern compilation of etiology of invasive bacterial infection in infants

Woll et al present the compilation of bacteriologically confirmed bloodstream infection (BSI) and meningitis in infants <60 days of age who were evaluated in 11 children's hospital emergency departments over 5 years, 2011-2016. They also assessed infectious etiologies by weeks of age, and susceptibility of organisms to frequently used regimens for empiric therapy. Of 442 infants identified with confirmed invasive bacterial infection, approximately 80% had BSI, 14% had meningitis with BSI, and 6% had meningitis without BSI. Positive blood cultures represented 2% of those tested, and positive CSF cultures represented 0.7% of samples tested. Group B Streptococcus was the most common pathogen (37%), followed by E coli (31%) and Staphylococcus aureus (10%). More than 95% of pathogens would be expected to be susceptible to an empiric regimen of ampicillin plus gentamicin, or ampicillin plus a third-generation cephalosporin, but only 89% to a third-generation cephalosporin alone. Strengths of the study are its relatively large number of cases, and inclusion of infants evaluated across 11 children's hospitals. The reader should be cognizant that the primary focus of the study was only those infants with BSI or meningitis or both. The data are useful as a reliable summary of relative age-predictable prevalence of the most serious bacterial infections in very young infants, and of empiric antibiotic regimens to provide life-saving therapy empirically on the day of coming to medical attention. Article page 210 ▶ Epidemiology and Etiology of Invasive Bacterial Infection in Infants ≤60 Days Old Treated in Emergency DepartmentsThe Journal of PediatricsVol. 200PreviewTo help guide empiric treatment of infants ≤60 days old with suspected invasive bacterial infection by describing pathogens and their antimicrobial susceptibilities. Full-Text PDF

Invasive Bacterial Infections in Infants Younger Than 60 Days With Skin and Soft Tissue Infections.

The objective of this study was to describe the frequency of invasive bacterial infections (IBIs) in young infants with skin and soft tissue infections (SSTIs) and the impact of IBI evaluation on disposition, length of stay (LOS), and cost. This retrospective (2009-2014) cohort study used data from 35 children's hospitals in the Pediatric Health Information System. We included infants younger than 60 days who presented to an emergency department (ED) with SSTI. Invasive bacterial infection was defined as bacteremia/sepsis, bone/joint infection, or bacterial meningitis. Readmission and return ED visits within 30 days were evaluated to identify missed IBIs for infants. A total of 2734 infants were included (median age, 33 days; interquartile range [IQR], 21-44); 62% were hospitalized. Invasive bacterial infection was identified in 2%: bacteremia (1.8%), osteomyelitis (0.1%), and bacterial meningitis (0.1%). Hospitalization occurred in 78% of infants with blood cultures, 95% with cerebrospinal fluid cultures, and 23% without cultures. Median hospitalization LOS was 2 days (IQR, 1-3). Median cost was US $4943 for infants with cerebrospinal fluid cultures (IQR, US $3475-6780) compared with US $419 (IQR, US $215-1149) for infants without IBI evaluations (P < 0.001). Five infants (0.2%) returned to the ED within 30 days with new IBI diagnoses (4 bacteremia, 1 meningitis). Invasive bacterial infection occurs infrequently in infants younger than 60 days who present to children's hospital EDs with SSTI. Bacteremia is the most common IBI. More extensive evaluation for IBI is associated with increased rate of admission, LOS, and cost. Further studies are needed to evaluate the safety of a limited IBI evaluation in young infants with SSTI.

Epidemiology and Etiology of Invasive Bacterial Infection in Infants ≤60 Days Old Treated in Emergency Departments

To help guide empiric treatment of infants ≤60 days old with suspected invasive bacterial infection by describing pathogens and their antimicrobial susceptibilities. Cross-sectional study of infants ≤60 days old with invasive bacterial infection (bacteremia and/or bacterial meningitis) evaluated in the emergency departments of 11 children's hospitals between July 1, 2011 and June 30, 2016. Each site's microbiology laboratory database or electronic medical record system was queried to identify infants from whom a bacterial pathogen was isolated from either blood or cerebrospinal fluid. Medical records of these infants were reviewed to confirm the presence of a pathogen and to obtain demographic, clinical, and laboratory data. Of the 442 infants with invasive bacterial infection, 353 (79.9%) had bacteremia without meningitis, 64 (14.5%) had bacterial meningitis with bacteremia, and 25 (5.7%) had bacterial meningitis without bacteremia. The peak number of cases of invasive bacterial infection occurred in the second week of life; 364 (82.4%) infants were febrile. Group B streptococcus was the most common pathogen identified (36.7%), followed by Escherichia coli (30.8%), Staphylococcus aureus (9.7%), and Enterococcus spp (6.6%). Overall, 96.8% of pathogens were susceptible to ampicillin plus a third-generation cephalosporin, 96.0% to ampicillin plus gentamicin, and 89.2% to third-generation cephalosporins alone. For most infants ≤60 days old evaluated in a pediatric emergency department for suspected invasive bacterial infection, the combination of ampicillin plus either gentamicin or a third-generation cephalosporin is an appropriate empiric antimicrobial treatment regimen. Of the pathogens isolated from infants with invasive bacterial infection, 11% were resistant to third-generation cephalosporins alone.

Prevalence of Invasive Bacterial Infections in Infants &amp;lt;60 Days with Skin and Soft Tissue Infections

Prevalence of Invasive Bacterial Infections in Infants &amp;lt;60 Days with Skin and Soft Tissue Infections

Febrile infant update.

The approach to febrile young infants remains challenging. This review serves as an update on the care of febrile infants less than 90 days of age with a focus on the changing epidemiology of serious bacterial infection (SBI), refinement of management strategies based on biomarkers, and the development of novel diagnostics. There is high variability in the emergency department management of febrile young infants without significant differences in outcomes. C-reactive protein (CRP) and procalcitonin have emerged as valuable risk-stratification tests to identify high-risk infants. When interpreting automated urinalyses for suspected urinary tract infection (UTI), urine concentration influences the diagnostic value of pyuria. Novel diagnostics including RNA biosignatures and protein signatures show promise in better identifying young febrile infants at risk of serious infection. The majority of febrile infants with an SBI will have a UTI but the diagnosis of invasive bacterial infection in infants continues to be challenging. The use of procalcitonin and CRP as biomarkers in prediction algorithms facilitates identification of low-risk infants.

Early-Onset Neonatal Sepsis in the Era of GBS Prophylaxis

The incidence of early-onset neonatal sepsis due to group B Streptococcus (GBS) has declined significantly following the implementation of intrapartum prophylaxis. Initial surveillance reports raised concerns that screening and prophylaxis for GBS would result in an increased burden of antibiotic-resistant Escherichia coli neonatal sepsis. In the current study, investigators reviewed 10 years of population-based surveillance data on invasive bacterial infections in infants …

Evaluation of Sepsis Screening Tests in Severe Bacterial Infections in Infants beyond Neonatal Age

Background and Aims: Blood culture has its limitations in detecting serious bacterial infections in infants. There is a need for a test or group of tests which can detect the condition early. Sepsis scoring [CRP, micro ESR, total leucocyte count (TLC), toxic granules, I:T ratio & band cells] have traditionally been used in neonatal age group but very few studies have evaluated these tests in invasive bacterial infections in infants. In this study we have evaluated the role of these tests both individually and in union in predicting the presence of serious bacterial infection. Methods: 65 patients within the age group of 1 month to 1 year admitted with suspected sepsis, meningitis, consolidation, and urinary tract infection were included in the case control type of study with healthy children taken as controls. Results: CRP had highest sensitivity of 77.77 %. The sensitivity of both micro ESR and TLC was 66.66% but they had a poor specificity and positive predictive value. Highest negative predictive value was observed for toxic granules (89.28%). Highest specificity of 87.50% was observed for I:T ratio. A combination of micro ESR & TLC have shown maximum specificity of 90.47% and negative predictive value of 94.70%. When three tests were combined, a combination of micro ESR, ESR and toxic granules had 100% sensitivity, 100% negative predictive value and 80% accuracy. Conclusions: The study indicates that a collective use of simple and low cost screening tests can be a definitive aid to diagnosis of sepsis. Their rapid nature can help us in deciding about appropriate management at the earliest.

Haemophilus influenzae type-b and non-b-type invasive diseases in urban children (

To prospectively study the epidemiology and antibiotic resistance of Haemophilus infuenzae isolates from invasive infections in children. Children (<5years) with pneumonia, meningitis and septicemia from three hospitals in Dhaka, Bangladesh were enrolled (1999-2003); clinical and laboratory data, and blood for cultures were collected. Cerebrospinal fluid (CSF) of meningitis cases was analyzed (Gram stain, culture and biochemical tests). Hib antigen was detected by latex agglutination (LA) in culture-negative pyogenic CSF and PCR was done for bexA gene in culture- and LA-negative pyogenic CSF. Antibiotic susceptibility was determined by E-Tests and beta-lactamase by nitrocefin stick. Seventy-three cases of H. influenzae infections (46 of 293 meningitis cases, 25 of 1493 pneumonia cases, 2 of 48 septicemia cases) were detected; 63%, 34% and 3% of them had meningitis, pneumonia and septicemia respectively. H. influenzae type b (Hib) caused infections in 80.8% of cases (60.3% meningitis, 20.5% pneumonia). Most (86%) infections clustered in 4-12month infants. The case-fatality in pneumonia was 8% compared to 19% in meningitis. H. influenzae isolates from pneumonia and meningitis children were equally resistant to antibiotics (46% vs 43%). Of 10 drugs tested, isolates were resistant to ampicillin (31%), chloramphenicol (42%), trimethoprim-sulfamethoxazole (44%) and azithromycin (1.4%). Multidrug-resistant (MDR) strains were equally prevalent in Hib (31%) and non-b-type (29%) isolates, and in pneumonia (31%) and meningitis (34%) cases. None was resistant to amoxicillin-clavulanate, ceftriaxone, ciprofloxacin, levofloxacin, moxifloxacin, and gatifloxacin. Of all H. influenzae infections, 40%, 4.4% and 100% of pneumonia, meningitis and septicemia cases were caused by other serotypes or non-typeable strains. All ampicillin-resistant-strains produced beta-lactamase without detection of beta-lactamase-negative-ampicillin-resistant (BLNAR) strains. Hib is a leading cause of invasive bacterial infections in infants. Multidrug-resistant H. influenzae is common and requires amoxicillin-clavulanate, ceftriaxone or azithromycin as empirical therapy with specific recommendation for use of ceftriaxone for treatment of meningitis particularly MDR cases. New fluoroquinolines has potential utility. An effective national Hib vaccination programme is essential in Bangladesh although non-Hib infections will remain an issue.

Akutes Fieber beim Kleinkind

The body temperature is influenced among other things by time of day or age and exhibits a Gaussian inter-individual distribution. If measured orally, normal values vary between 35.6 degrees C and 38.2 degrees C. Temperature exceeding the 99th percentile (> 37.7 degrees C) can therefore be interpreted as fever. Nevertheless, an universally accepted definition of fever does not exist. Viral infection is the most frequent cause of acute fever in infants, even in the absence of a source. Bacterial infections are by far a rarer reason. Nevertheless, below the age of 3 years, acute fever is a ticklish issue because of the higher risk for rapidly evolving life-threatening invasive bacterial infections. Following introduction of vaccination against Haemophilus influenzae type b (Hib), Streptococcus pneumoniae has advanced to the most frequent cause of invasive bacterial infections in infants. Fever is rarely seen in newborns (age 1-28 days), but when present, it is more frequently serious. Around 12% of these newborns show an invasive bacterial infection. Therefore, a full workup for sepsis is strongly indicated. This includes cultures of blood,urine and cerebrospinal fluid plus a chest radiography. In addition, immediate start of an empirical intravenous antibiotic therapy and monitoring in a hospital setting are necessary. Apart from this exception, primary antibiotic therapy is rarely necessary in fever without a detectable focus and source. Also, routine prescription of antipyretics is not indicated. Though paracetamol may improve well-being and drinking behavior of infants, it does neither shorten the duration of fever duration, nor prevent febrile seizures.

Infections à pneumocoque

Currently, pneumococcal infections are a public health problem. Streptococcus pneumoniae is a leading cause of community acquired invasive and non invasive bacterial infections in infants and young children, more specifically among those under five years. Pneumococcal invasive infections, in particular meningitis, carry a mortality upper than 8 % and a high risk of sequelae. Atypical clinical expression is frequent in youngest children. Membrane immunochromatography for rapid detection of urinary C-polysaccharide antigen is one of the advances for biological diagnosis, but it remains to be evaluated in children. Due to the increasing prevalence of penicillin-resistant pneumococci, treatment has to be adapted to clinical and epidemiological features. Frequent, serious, antibiotic-resistant characters of pneumococcal infections plea for vaccine. In France, Pneumo 23 ® indications were extended in 1998, and pneumococcal conjugate vaccine Prevenar ® indications were modified in 2002. Local, national and international surveys are needed to adapt treatment and vaccine strategies.

Bacterial infections in infants 60 days and younger: epidemiology, resistance, and implications for treatment.

To establish what might be more optimal initial antibiotic therapy for suspected invasive bacterial infections in infants 60 days or younger who are evaluated in the emergency department (ED). Urban university-affiliated pediatric referral center with an average yearly ED census of 52000 visits during the study period. We assembled a retrospective case series of all positive blood, urine, and cerebrospinal fluid cultures in children 60 days or younger from January 1, 1994, through December 31, 1997, obtained from both inpatients and patients initially evaluated in the ED. From this case series we determined the frequency of bacterial pathogens responsible for such infections in this age group. Pathogens were defined as group B streptococcus, various enteric gram-negative rods (GNRs), Listeria monocytogenes, enterococcus, Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae type B, and Staphylococcus aureus. A subgroup analysis was performed to determine resistance patterns among the GNRs isolated from patients evaluated in the ED. A total of 367 pathogens were isolated: 187 (51.0%) in the neonatal intensive care unit, 153 (41.7%) in the ED, 20 (5.4%) in the inpatient wards, and 7 (1.9%) in the pediatric intensive care unit. Of the 121 pathogens isolated from 120 ED patients that were eligible for review, 94 (77.7%) were in the urine only, 16 (13.2%) in blood only, 4 (3.3%) in cerebrospinal fluid only, 3 (2.5%) in blood and cerebrospinal fluid, and 4 (3.3%) in blood and urine. Organisms isolated included GNRs (n = 96, 79.3%), group B streptococcus (n = 14, 11.6%), enterococcus (n = 7, 5.8%), S. pneumoniae (n = 3, 2.5%), and N. meningitidis (n = 1, 0.8%). No Listeria were isolated. Of the 96 GNRs isolated, 60 (62.5%; 95% confidence interval, 52.8%-72.1%) were ampicillin resistant. All were sensitive to gentamicin sulfate and cefotaxime sodium. Our results reveal 2 important facts: (1) during a 4-year period, no isolates of Listeria were identified from any patients 60 days or younger; and (2) of the 96 GNRs isolated from patients in the ED, more than 60% were ampicillin resistant. These data suggest that in similar centers with a low incidence of infection with Listeria and high levels of ampicillin resistance among GNRs, empiric use of ampicillin as part of a combination for presumed bacterial infections in patients 60 days or younger initially evaluated in the ED may be neither necessary nor beneficial. Consideration should be given to empiric initial antibiotic therapy using a third-generation cephalosporin with or without gentamicin.