Low Risk Of Invasive Bacterial Infection Research Articles

Prevalence of invasive bacterial infection in febrile infants ≤90 days with a COVID-19 positive test: a systematic review and meta-analysis

BackgroundFebrile infants with an infection by influenza or enterovirus are at low risk of invasive bacterial infection (IBI).ObjectiveTo determine the prevalence of IBI among febrile infants ≤90 days old with...

Is Ophthalmia Neonatorum Associated With Invasive Bacterial Infection? A Single-Center Retrospective Study.

Ophthalmia neonatorum (ON) is a conjunctivitis occurring in neonates and can be caused by multiple bacterial pathogens. The risk of invasive bacterial infection (IBI) in neonates with ON is poorly known. Our objectives were to document the association of ON with IBI in term neonates and to investigate practice variation. This was a retrospective observational study of all neonates who presented to a single emergency department (ED) between January 2018 and December 2019. Participants were all children with a final diagnosis of ON according to the treating physician as registered in the ED computerized database. Newborns with craniofacial malformations and premature infants were excluded. The primary outcome was IBI as defined by growth of any bacterial pathogen in the blood or cerebrospinal fluid. Perinatal risk factors, ED visit details (symptoms on presentation, management, and treatment plan) as well as complications (ocular morbidity, death, and unscheduled return visits) were collected. Data were analyzed using descriptive statistics. Fifty-two term neonates were included. There were no cases of IBI associated with ON (0%; 95% confidence interval [CI], 0%-6.9%). Six ocular bacterial infections were identified, one of which was Chlamydia trachomatis. Although there were no IBIs, ocular complications, deaths, or unscheduled return visits to the ED, there was a wide variation in physician's management of ON. Physicians ordered investigations in 49% (95% CI, 34%-62%) of neonates, prescribed antibiotics to 87% (95% CI, 74%-94%), and involved specialists in 39% (95% CI, 27%-52%) of cases. Emergency department presentations of term neonates with ON are associated with a low risk of IBI. A better understanding of the current practice variation is needed to inform clinical guidelines for the management of neonates with ON presenting to the ED.

Rochester Criteria and Yale Observation Scale Score to Evaluate Febrile Neonates with Invasive Bacterial Infection

BackgroundFebrile neonates undergo lumbar puncture (LP), empiric antibiotic administration, and admission for increased risk of invasive bacterial infection (IBI), defined as bacteremia and meningitis. ObjectiveMeasure IBI prevalence in febrile neonates, and operating characteristics of Rochester Criteria (RC), Yale Observation Scale (YOS) score, and demographics as a low-risk screening tool. MethodsSecondary analysis of healthy febrile infants < 60 days old presenting to any of 26 emergency departments in the Pediatric Emergency Care Applied Research Network between December 2008 and May 2013. Of 7334 infants, 1524 met our inclusion criteria of age ≤ 28 days. All had fevers and underwent evaluation for IBI. Receiver operator characteristic (ROC) curve and transparent decision tree analysis were used to determine the applicability of reassuring RC, YOS, and age parameters as an IBI low-risk screening tool. ResultsOf 1524 neonates, 2.9% had bacteremia and 1.5% had meningitis. After applying RC and YOS, 15 neonates were incorrectly identified as low risk for IBI (10 bacteremia, 4 meningitis, 1 bacteremia, and meningitis). Age ≤ 18 days was a statistically significant variable ROC (area under curve 0.63, p < 0.05). Incorporating age > 18 days as low-risk criteria with reassuring RC and YOS misclassified 7 IBI patients (6 bacteremia, 1 meningitis). ConclusionThirty percent of febrile neonates met low-risk criteria, age > 18 days, reassuring RC and YOS, and could avoid LP and empiric antibiotics. Our low-risk guidelines may improve patient safety and reduce health care costs by decreasing lab testing for cerebrospinal fluid, empiric antibiotic administration, and prolonged hospitalization. These results are hypothesis-generating and should be verified with a randomized prospective study.

A Culture of Too Many Blood Cultures.

A Culture of Too Many Blood Cultures.

Febrile Infants ≤60 Days Old With Positive Urinalysis Results and Invasive Bacterial Infections.

We aimed to describe the clinical and laboratory characteristics of febrile infants ≤60 days old with positive urinalysis results and invasive bacterial infections (IBI). We performed a planned secondary analysis of a retrospective cohort study of febrile infants ≤60 days old with IBI who presented to 11 emergency departments from July 1, 2011, to June 30, 2016. For this subanalysis, we included infants with IBI and positive urinalysis results. We analyzed the sensitivity of high-risk past medical history (PMH) (prematurity, chronic medical condition, or recent antimicrobial receipt), ill appearance, and/or abnormal white blood cell (WBC) count (<5000 or >15 000 cells/μL) for identification of IBI. Of 148 febrile infants with positive urinalysis results and IBI, 134 (90.5%) had bacteremia without meningitis and 14 (9.5%) had bacterial meningitis (11 with concomitant bacteremia). Thirty-five infants (23.6%) with positive urinalysis results and IBI did not have urinary tract infections. The presence of high-risk PMH, ill appearance, and/or abnormal WBC count had a sensitivity of 53.4% (95% confidence interval: 45.0-61.6) for identification of IBI. Of the 14 infants with positive urinalysis results and concomitant bacterial meningitis, 7 were 29 to 60 days old. Six of these 7 infants were ill-appearing or had an abnormal WBC count. The other infant had bacteremia with cerebrospinal fluid pleocytosis after antimicrobial pretreatment and was treated for meningitis. The sensitivity of high-risk PMH, ill appearance, and/or abnormal WBC count is suboptimal for identifying febrile infants with positive urinalysis results at low risk for IBI. Most infants with positive urinalysis results and bacterial meningitis are ≤28 days old, ill-appearing, or have an abnormal WBC count.

Early discharge of pediatric patients with cancer, fever, and neutropenia with low-risk of systemic infection.

Ambulatory therapy in low-risk patients with cancer, fever, and neutropenia seems to be a secure and effective alternative. This study aimed to compare the effectiveness and safety of the antimicrobial treatment in early discharge vs. in-hospital treatment in children with cancer and febrile neutropenia (FN) with low risk of invasive bacterial infection (IBI). Quasi-experimental design with a historical cohort control group. Children with cancer during an episode of FN and low risk of IBI were included. The control group were inpatient children that received intravenous piperacillin/tazobactam. The experimental group was early discharge patients, who received 48 h of IV treatment and were switched to oral treatment. Outcomes: fever resolution, readmissions, and mortality. Eighty low-risk FN episodes were included; the median age was 6 years old (2.6-11 years), and 43 (54%) were female. Main diagnoses were solid tumors (52 patients) and leukemia or lymphoma (28 patients). Forty-three patients received in-hospital treatment, and 37 were selected for early discharge (31 patients received ciprofloxacin and six received amoxicillin/clavulanate). Two patients were readmitted, one due to a relapse of fever with tumor progression and the other due to epistaxis. Adverse effects occurred in 21.6% of the early discharge group and 12% of the inpatient treatment group (p = 0.04). Early discharge in pediatric patients with cancer, fever, and neutropenia is an acceptable and safe alternative for low-risk patients.

Fever in Infants: Assessing Variability in Sepsis Evaluation

BackgroundFever is a common presentation of infants resulting in frequent medical visits. Since fever may be the sole sign of invasive bacterial infection (IBI) in infants less than 3 months of age, invasive testing is often performed. Many physicians are guided by standardized criteria, which were created to aid in determining those at low risk of IBI. Though these criteria exist, there is limited guidance regarding appropriate testing in the first month of life and wide variability in practice during the first 90 days. An American Academy of Pediatrics national quality improvement collaboration, Reducing Excessive Variability in Infant Sepsis Evaluation, is standardizing management of these infants. This study evaluates current institutional practice in assessing febrile infants.MethodsRetrospective chart review of well-appearing previously healthy term infants with no obvious source of fever on initial examination between the ages of 0–90 days presenting with documented or reported fever to either a tertiary emergency department or inpatient hospital, with specific International Classification of Diseases codes over 1 year period. The infants were then separated into three groups: 0–28, 29–60 and 61–90 days.ResultsOf 83 infants meeting criteria, 10% had IBI with 75% of these being urinary tract infection. Evaluation with complete blood count (CBC), blood culture, urinalysis (UA) and urine culture varied between groups from 84%, 87% and 29% respectively. Within this latter group, 75% were underimmunized. CBC results were abnormal in 64% of all infants with leukopenia the most common abnormality. Of those with bacterial infection and where CBC was obtained, 50% had leukopenia and 50% had normal white blood cell (WBC) count. UA collection differed between the groups from 88%, 87% and 68% and lumbar puncture attempts performed in 84%, 30% and 4%. CXR was obtained in 27% of infants and all were negative; 40% of these infants that underwent imaging were asymptomatic.ConclusionMost criteria rely on leukocytosis to identify high risk for IBI; infants with IBI in this study had leukopenia or normal WBC counts. Sepsis evaluation in febrile infants varies tremendously and an updated guideline for identifying IBI could minimize unnecessary imaging, laboratory testing and unwarranted antibiotic therapy.Disclosures All authors: No reported disclosures.

Febrile young infants with altered urinalysis at low risk for invasive bacterial infection. a Spanish Pediatric Emergency Research Network's Study.

Urinary tract infection (UTI) is the most common serious bacterial infection (SBI) in infants younger than 90 days of age. Many physicians admit infants younger than 90 days old because of their greater risk of developing invasive bacterial infections (IBIs), secondary to UTI. The primary objective of this study was to design a prediction model to identify febrile infants younger than 90 days old with an altered urinalysis who were at low risk for IBI and suitable for outpatient management : Prospective multicenter study included 19 hospitals that are members of the Spanish Pediatric Emergency Research Group of the Spanish Society of Pediatric Emergencies. Febrile infants younger than 90 days old with altered urinalysis were included. A total of 766 (22.5%) infants with altered urine dipstick were analyzed. Fifty (6.5%) of them developed IBI, 39 (78.0%) secondary to UTI. Patients were at low risk for IBI if they were well appearing at arrival to the emergency department, were older than 21 days and had procalcitonin and C-reactive protein (CRP) blood values lower than 0.5 ng/mL and 20 mg/L, respectively. These factors were used to create a prediction model for IBI secondary to UTI, with a sensitivity of 100% (95% CI: 89.3-100) and a negative predictive value of 100% (95% CI: 97.5-100). We have derived a highly accurate prediction model for IBI in febrile infants with altered urinalysis. Given these results, outpatient management might be suitable for 1 of each 4 infants diagnosed, with a considerable improvement in resource utilization.

Prospective evaluation of a model of prediction of invasive bacterial infection risk among children with cancer, fever, and neutropenia.

A risk prediction model for invasive bacterial infection (IBI) was prospectively evaluated among children presenting with cancer, fever, and neutropenia. The model incorporated assessment of 5 previously identified risk factors: serum level of C-reactive protein (CRP) >/=90 mg/L, hypotension, identification of relapse of leukemia as the cancer type, platelet count of </=50,000 platelets/mm(3), and recent receipt of chemotherapy [16]. Children were uniformly evaluated at enrollment and were classified as having high or low risk for IBI according to a model that considers the number and type of variables present. Of the 263 febrile episodes evaluated during a 17-month period, 140 (53%) were in IBI-positive children. The sensitivity, specificity, and positive and negative predictive values of the model were 92%, 76%, 82%, and 90%, respectively. Identification of these 5 risk factors during the first 24 h of hospitalization was helpful in discriminating between children with a high or low risk for IBI.

Neutropenia febril en el niño con cáncer: Conceptos actuales sobre criterios de riesgo y manejo selectivo

The risk for invasive bacterial infection (IBI) in cancer pediatric patients with febrile neutropenia, is variable. Clinicians worldwide are increasingly considering selective strategies for children at low risk for IBI, including shortened antimicrobial course, early hospital discharge, oral antimicrobial treatment, and management as outpatients. These strategies would significantly benefit these children and health care systems. The critical issue is to identify the most reliable risk factors useful for selection of those individuals who are at low risk for IBI. In Chile, during the past 10 years, a group of physicians from the Subcommittee of Infectious Diseases of the National Child Program of Antineoplastic Drugs and the University of Chile have worked to develop more selective strategies for pediatric patients with cancer, fever and neutropenia. During 1996-1997 we identified risk factors of IBI in a group of 447 febrile neutropenic episodes. During 1999-2000 we validated these risk factors in a prospective study that included 263 febrile neutropenic episodes. A model of risk prediction was developed and is currently being evaluated for the selection of low risk patients who are treated as inpatients for 24 hours, followed by outpatient treatment.