Predictor Of Serious Bacterial Infection Research Articles

Usefulness of C-Reactive Protein and Clinical Characteristics in Identifying Severe Bacterial Infection in Children with Fever without Source.

Fever continues to be the most frequent cause of care in the pediatric population. The uses of invasive and unnecessary tests result in discomfort to the patients. Local epidemiological data could help to refine screening strategies, especially in low resources settings. The present study aims to describe the prevalence of serious bacterial infections in infants with fever without source and to evaluate the usefulness of clinical and laboratory parameters in the identification of serious bacterial infections. We included all children aged 0-36 months presenting with fever without source between January 2015 and December 2017. Demographic and clinical characteristics, investigations, and management procedures were recorded at the time of inclusion. Potential predictors of serious bacterial infections were compared between patients with and without serious bacterial infections. In total, 137 patients were included. Serious bacterial infections were diagnosed in 41 patients (29.9%; 95% CI, 22%-38%). The most frequent diagnosis in serious bacterial infection patients was urinary tract infection (78%). Serum C-reactive protein levels greater than 80 mg/L (odds ratio, 2.79 [1.14,6.86]) and total days with fever (odds ratio, 2.56 [1.81,3.62]) showed a significant association to predict serious bacterial infections. Most infants with fever without source presented self-limited febrile syndromes without evidence of severe bacterial infection. C-reactive protein levels greater than 80 mg/L and the number of previous days with fever were variables associated with the presence of serious bacterial infections. Our results need to be validated in other tropical countries.

The prevalence of serious bacterial infections in infants 90 days and younger with viral respiratory tract infections.

To determine the prevalence and risk factors of serious bacterial infections (SBIs) in infants 90 days and younger with a confirmed respiratory tract infection (RTI). A retrospective cross-sectional study was carried out of infants 90 days and younger who were admitted to King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia, from January 2019 to December 2020, with polymerase chain reaction (PCR)-proven RTI. Cultures from the urine, blood, and cerebrospinal fluid were reviewed with the patients' demographic information and clinical presentation. Of 322 patients with a viral RTI, 21 (6.5%) had a concurrent urinary tract infection (UTI), and no patients had bacteremia or bacterial meningitis. The risk of a concurrent SBI was 4 times higher in neonates (odds ratio [OR]=4.66, 95% confidence interval [CI]: [1.32-16.47]). Previously healthy infants were at lower risk to have a SBI in comparison to those with chronic diseases or renal abnormalities (OR=0.23, 95% CI: [0.09-0.61]). In addition, male gender (OR=3.49, 95% CI: [1.07-11.38]) and abnormal urinalysis (OR=4.12, 95% CI: [1.48-11.42]) were predictors of SBIs. There was no statistically significant association between the number or type of detected viruses and SBIs. No cases of invasive bacterial infections were found in infants with PCR-proven viral RTIs. There is a risk of having a concurrent UTI in this cohort of patients. Neonates had a higher risk of UTIs as compared to older infants.

Candidate Biomarkers for the Detection of Serious Infections in Children: A Prospective Clinical Study.

Serious bacterial infections (SBI) in children are associated with considerable morbidity and mortality, and their early identification remains challenging. The role of laboratory tests in this setting is still debated, and new biomarkers are needed. This prospective, observational, single-center study aims to evaluate the diagnostic role of blood biomarkers in detecting SBI in children presenting with signs of systemic inflammatory response syndrome (SIRS). A panel of biomarkers was performed, including C-reactive protein (CRP), procalcitonin (PCT), white blood cell count (WBC), absolute neutrophil count (ANC), interleukin (IL)-6, IL-8, IL-10, human terminal complement complex (C5b-9), Plasmalemma-Vesicle-associated protein 1 (PV-1), Intercellular Adhesion Molecule-1 (ICAM-1), and Phospholipase A2 (PLA2). Among 103 patients (median age 2.9 years, 60% males), 39 had a diagnosis of SBI (38%). Significant predictors of SBI were CRP (p = 0.001) and ICAM-1 (p = 0.043). WBC (p = 0.035), ANC (p = 0.012) and ANC/WBC ratio (p = 0.015) were also significantly associated with SBI in children without pre-existing neutropenia. ROC curves, however, revealed suboptimal performance for all variables. Nevertheless, a model that combined CRP and ANC/WBC ratio had more in-depth diagnostic accuracy than either of the two variables. Overall, this study confirms the limited usefulness of blood biomarkers for the early diagnosis of SBI. WBC, ANC, ANC/WBC ratio, CRP, and ICAM-1 showed the best, albeit moderate, diagnostic accuracy.

Predictors of serious bacterial infections using serum biomarkers in an infant population aged 0 to 90 days: a prospective cohort study

ObjectiveYoung febrile infants represent a vulnerable population at risk for serious bacterial infections (SBI). We aimed to evaluate the diagnostic accuracy of components of the complete blood count in comparison...

Thrombocytosis as a Predictor of Serious Bacterial Infection in Febrile Infants

Most of the febrile infants <90 days old will have no more than a mild viral infection but there is a substantial minority that will be diagnosed as having serious bacterial infection at a reported prevalence of 10-14%. A simple, readily available, inexpensive diagnostic marker that yields results quickly and also accurately identifies bacterial infections in febrile infants would be of great value in management of these infants. This study aims to assess the role of thrombocytosis in predicting serious bacterial infection in young febrile infants beyond neonatal period. A hospital based cross-sectional observational study was conducted from May 2016 to April 2017 on 76 febrile infants of age group 29-90 days in Kanti Children's Hospital. The incidence of serious bacterial infection was found 43 (56.6%). Thrombocytosis, elevated C-reactive protein and pyuria were significantly higher in serious bacterial infection cases (p value <0.05). Thrombocytosis alone had the sensitivity of only 53.5%, but had specificity of 90.9%. Elevated C-reactive protein had the best sensitivity (81.4%). Combination of leukocytosis, elevated C-reactive protein, pyuria and thrombocytosis had better sensitivity (93.0%) than these parameters alone. The overall ability of platelet count to identify infants with SBI was only moderate (AUC: 0.722). Elevated C-reactive protein was found to have better ability to identify infants with serious bacterial infection (AUC: 0.846). Thrombocytosis is a common finding in young infants diagnosed with serious bacterial infection. It has however, moderate ability in identifying infants with serious bacterial infection. Combining thrombocytosis with elevated C-reactive protein, leukocytosis and pyuria has better sensitivity in diagnosing serious bacterial infection than these individual parameters alone. Hence, combining these parameters may help in early prediction of febrile young infants at risk of serious bacterial infection.

Thrombocytosis in Febrile Illness in Children of Age Three Months to 14 Years at a Tertiary Care Hospital of Nepal

Background and Objectives: Acute febrile illness is common presentation in children. Thrombocytosis can be used as a predictor of febrile illness in children. The objectives of this study were to find out the prevalence and causes of thrombocytosis among febrile children and to access the utility of platelet count as a potential predictor of serious bacterial infection alone or in association with other predictors.Material and Methods: A cross-sectional descriptive study was done in 290 febrile children following convenience sampling method. Statistical analysis was done using SPSS. Univariate analysis using chi-square test for categorical and independent samples and “t” test for continuous variables were done.Results: Thrombocytosis was present in 13.1% of cases. Most cases had mild thrombocytosis (10%) whereas moderate thrombocytosis was present in 2.8% of cases and 0.3% cases had severe thrombocytosis. Lymphocyte level, erythrocyte sedimentation rate and C-reactive protein also showed a significant association with thrombocytosis (p&lt;0.05). Serious bacterial infection was present in 209 cases out of which 30 children had thrombocytosis but was not significant compared to children with non serious bacterial infection with thrombocytosis (p=0.171).Conclusion: Thrombocytosis was found to have an association with febrile illnesses. More so, it indicated a fair discriminate ability to diagnose infectious cause of disease. However there was no statistical significance between thrombocytosis and serious bacterial infection.

Thrombocytosis as an additional predictor of serious bacterial infection in febrile young infants

Background: To estimate the incidence of Reactive Thrombocytosis among febrile young infants and to assess the utility of platelet count as a potential predictor of Serious bacterial infection (SBI).Methods: This study was conducted as a prospective study between January 2014 to September 2015 at the tertiary care pediatric unit, Alappuzha, India. The participants were all infants 30 to 89 days of age, admitted with rectal temperature &gt;38°C. The results of the sepsis evaluation on admission were recorded. SBI included cases of occult bacteremia, urinary tract infection, bacterial meningitis, pneumonia, bacterial gastroenteritis and infections of the soft tissues and bones.Results: Of the 120 infants studied, 24 (28%) had SBI. Platelet count was significantly higher in infants with SBI compared to those without {Platelet count ≥ 4.5lakhs /mm3 in SBI (70.3%) vs. Non SBI (30.2%). Mean platelet count 4.82±1.4 in SBI vs. 3.9±1.2 in non SBI which was statistically significant (p&lt;0.05). Thrombocytosis had moderate ability in predicting SBI (Area under curve area under the curve: 0.720). The combination of platelet count ≥450,000/mm3, WBC ≥15,000/mm3, C-reactive protein ≥1 mg/dl, pyuria ≥5 White blood cells (WBC) per High power field (HPF) and erythrocyte sedimentation rate (ESR) &gt;30mm/hr resulted in identification of all infants with SBI.Conclusions: Thrombocytosis in combination with leukocytosis, elevated C-reactive protein, ESR, and pyuria, may help in early recognition of febrile young infants at risk for SBI.

Evaluation of the bedside Quikread go® CRP test in the management of febrile infants at the emergency department.

Recently C-reactive protein (CRP) point-of-care tests have been developed. We aimed to validate a bedside CRP test (QuikRead go® CRP), to compare it with the laboratory CRP (ARCHITECT c8000 Abbott, Germany) test in children with fever without source (FWS), and to evaluate the optimal CRP cut-off value to identify those patients at a high risk for serious bacterial infection (SBI). The CRP bedside test was prospectively performed in capillary blood samples concurrently with the laboratory CRP testing for 283 well-appearing infants aged 1 to 24months with FWS attending the emergency department (ED) between May 2013 and August 2015. The mean difference between the laboratory CRP and the QuikRead go CRP values was 0.71mg/L (p = 0.444). Pearson's correlation coefficient between the CRPs was r = 0.929 (p < 0.001). SBI was diagnosed in 34 patients (12.0%). The area under the receiver operating characteristics (ROC) curve obtained was 0.87 (95%CI: 0.82-0.90) for an optimal CRP cut-off value of > 10mg/L (sensitivity: 94.1%, specificity: 49.0%, positive predictive value: 20.1%, negative predictive value: 98.4%), as a predictor of SBI. Nearly 45% of the patients were at a low risk for SBI according to CRP value; thus, additional laboratory tests would have been hypothetically avoided. There was a very strong, positive correlation between the QuikRead go CRP test and laboratory CRP determination. The QuikRead go CRP test provides reliable results to rule out SBI. Its implementation at the ED would improve the management of infants with FWS.

Lab-score is a valuable predictor of serious bacterial infection in infants admitted to hospital.

Parents frequently bring their children to the Emergency Department (ED) because of the fever without apparent source (FWAS). To avoid possible complications, it is important to recognize serious bacterial infection (SBI) as early as possible. Various tests, including different clinical scores and scales, are used in the laboratory evaluation of patients. However, it is still impossible to predict the presence of SBI with complete certainty. Galetto-Lacour et al. developed and validated a risk index score, named Lab-score. Lab-score is based on the three predictive variables independently associated with SBI: procalcitonin (PCT), C-reactive protein (CRP), and urinary dipstick. The objective of this study was to assess the performance of the Lab-score in predicting SBI in well-appearing infants ≤ 180 days of age with FWAS, who presented to ED and were hospitalized with suspicion of having SBI. Based on this study findings, white blood cells count (WBC), CRP, PCT, and lab-score ≥ 3 were confirmed as useful biomarkers for differentiation between SBI and non-SBI. Also, receiver operating characteristic curve (ROC) analysis confirmed that all of them were useful for differentiation between SBI and non-SBI patients with the highest area under curve (AUC) calculated for the Lab-score. The results of this research confirmed its value, with calculated sensitivity of 67.7% and specificity of 98.6% in prediction of SBI in infants aged ≤ 180 days. Its value was even better in infants aged ≤ 90 days with sensitivity of 75% and specificity of 97.7%. In conclusion, we demonstrated the high value of lab-score in detecting SBI in infants under 6 months of age with FWAS.

6 PEM papers that could change your practice - #4 - predictors of serious bacterial infection

6 PEM papers that could change your practice - #4 - predictors of serious bacterial infection

Predictors of Serious Bacterial Infections in Pediatric Burn Patients With Fever

To determine predictors of serious bacterial infections in pediatric burn patients with fever (core temp ≥38.5°C), the authors conducted a retrospective review of medical records of pediatric (0-18 years) patients admitted to the Arizona Burn Center between 2008 and 2011 with greater than 5% TBSA and inpatient hospitalization for ≥72 hours. The study group comprised patients with a febrile episode during their inpatient stay. Serious bacterial infection (the primary outcome variable) was defined as: bacteremia, urinary tract infection, meningitis (blood, urine, or cerebrospinal fluid culture positive for a pathogen respectively), pneumonia, line, and wound infection. A generalized estimating equation analysis was done to predict the presence or absence of serious bacterial infection. Of 1082 pediatric burn patients hospitalized during the study period, 353 met the study eligibility criteria. A total of 108 patients (30.6%) had at least one fever episode (fever group). No difference in demographic characteristics was noted between the fever and no-fever groups; significant differences were observed for: third-degree TBSA, second-degree TBSA, total operating room visits, length of stay, Injury Severity Score, and death. A total of 47.2% of the patients had one or more episodes of fever with serious bacterial infection. In a generalized estimating equation predictive model, presence of a central line, second-, and third-degree TBSA were predictive of serious bacterial infection in burn patients with fever. In this study, individual clinical variables such as tachypnea and tachycardia were not predictive of serious bacterial infections, but the presence of a central line, and larger TBSA were significant predictors of serious bacterial infections. Younger age (P =.08) and ventilator support (P =.057) also approached significance as predictors of serious bacterial infections.

Vital signs should be maintained as continuous variables when predicting bacterial infections in febrile children

ObjectiveTo determine how vital signs such as heart and respiratory rates should be included in prediction models for serious bacterial infections (SBIs) in febrile children. Study Design and SettingProspective observational study of 1,750 febrile children aged <16 years, visiting the emergency department of a university hospital; of them 13% (n=222) had SBI. Common age-specific thresholds of heart and respiratory rates were used to define tachycardia and tachypnea. We compared seven strategies to handle vital signs as predictors of SBI (dichotomized or continuously in various ways). ResultsThe dichotomous predictors, namely tachycardia and tachypnea, containing information on the vital sign and age showed limited value to predict the presence of SBI (area under the receiver operating characteristic curve [AUC (ROC)]: 0.53 for heart rate and 0.55 for respiratory rate). In comparison, a model with age as a single continuous predictor resulted in an AUC of 0.58. Models with age and one of the vital signs included continuously showed the highest AUC (heart rate: 0.60 and respiratory rate: 0.63). ConclusionHeart and respiratory rates should be maintained as continuous variables in model development to predict SBI in febrile children, as dichotomization results in information loss and lower predictive ability.

Fever and laboratory profiles as predictors of serious bacterial infection in children

Background There is a debate on the use of high fever \\lith othermorbidities to predict serious bacterial infection (SBI). Bacterialinfection occurs in 3􀁉15% of children with fever of 2: 39°C.Various laboratory parameters including increased C􀁉reactiveprotein (CRP) levels, leukocyte counts, and absolute neutrophilcounts (AN C) have been studied for their usefulness in predictingthe occurrence of SBI, but with varied results. The ability todiscriminate whether a patient has a SBI can lead to improvedpatient management.Objective To evaluate fever of 2: 39°C, leukocyte counts of2: 15,000/mm3, ANC of 2: 1O,000/mm3 and CRP of 2: 10 mgiL aspredictors of SBI in children aged 1 month􀁉 18 years.Methods A case􀁉controlled study was conducted by collectingdata from medical records at Sanglah Hospital, Denpasar. Subjectsin the case group were diagnosed \\lith SBls (bacterial meningitis,bacterial pneumonia, bacteremia or sepsis, urinary tract infections,or bacterial gastroenteritis), and subjects in the control group nonserious bacterial infections (non􀁉SBI). Data was analyzed usingbivariate and multivariate methods \\lith 95% confidence intervalsand a statistical significance value ofP &lt;0.05.Results Sixty subjects were studied, \\lith 30 subjects in the casegroup and 30 in the control group. Baseline characteristics ofsubjects were similar between the two groups. Fever and CRP werepredictors ofSBI [OR8.71 (95% CI 1.61 t046.98), P 􀀁 0.009; andOR 6.20 (95% CI 1.58 to 24.24), P 􀀁 0.012, respectively].Conclusion Fever 2: 39°C and CRP 2: 10 mgiL were significantpredictors of serious bacterial infections in children. [Paediatrrndones, 2012;52:313-6].

Fever and laboratory profiles as predictors of serious bacterial infection in children

Fever and laboratory profiles as predictors of serious bacterial infection in children

Can urgency classification of the Manchester triage system predict serious bacterial infections in febrile children?

ObjectiveTo evaluate the discriminative ability of the Manchester triage system (MTS) to identify serious bacterial infections (SBIs) in children with fever in the emergency department (ED) and to study the...

Plasma IP-10 as a Predictor of Serious Bacterial Infection in Infants Less than 4 Months of Age

Early diagnosis of serious bacterial infection (SBI) in young infants is a difficult problem by clinical symptoms and signs. The goal of this study is to evaluate the predictive value of plasma IP-10 levels for early diagnosis of SBI in young infants <4 months of age. We enrolled pediatric patients who were <4 months of age with a clinical suspicion to have SBI admitted in neonatal intensive care unit or complete nursing unit of Pediatric Department of Kaohsiung Medical University Hospital. Blood was drawn for measurement of complete blood counts, C-reactive protein (CRP) and plasma IP-10 levels and microbiological cultures were obtained at the time of admission. There were 60 patients enrolled in this study. The SBI group (n = 21) have higher plasma IP-10 levels than those infants without SBI (n = 39) [median 104.8 (range 0-1457.1) versus 0 (range 0-129.3) pg ml(-1), P = 0.0161 after adjusting age]. A plasma IP-10 level >48.2 pg ml(-1) had the best diagnostic accuracy for indicating SBI {sensitivity 81.0% [95% confidence interval (CI) 71.1-90.1%]; specificity 94.9% [95% CI 65.4-87.0%]; positive likelihood ratio 15.9, negative likelihood ratio 0.2}. In infants who were <4 months of age with suspicion of SBI, IP-10 assay might be a good predictor. Key words: chemokine, IP-10, serious bacterial infection, young infant, C-reactive protein.

Risk score to stratify children with suspected serious bacterial infection: observational cohort study

ObjectivesTo derive and validate a clinical score to risk stratify children presenting with acute infection.Study design and participantsObservational cohort study of children presenting with suspected infection to an emergency department...

Thrombocytosis as a predictor of serious bacterial infection

Fever is one of the most common conditions requiring the attention of the pediatrician. The evaluation of an infant with febrile illness and no obvious focus of infection is a challenging task and can be expensive, timeconsuming and invasive. The general condition of the infant can be deceptive and does not assist reliably in clinical differentiation of a low risk versus high risk bacterial infection(1). This is compounded by the fact that no single laboratory test has been shown to identify infants with serious bacterial infection (SBI). Laboratory markers which have been used to predict SBI include raised white blood cell (WBC) counts, C-reactive protein (CRP), procalcitonin (PCT) and even interleukin-6 levels(2). WBC count, though easily available and used widely as a predictor of SBI, by itself, does not compare well with relatively more recent markers like CRP and PCT.

Reactive thrombocytosis in febrile young infants with serious bacterial infection

to estimate the incidence of reactive thrombocytosis among febrile young infants and to asses the utility of platelet count as a potential predictor of serious bacterial infection (SBI). retrospective study between January 2005 and December 2008. tertiary care pediatric unit. all infants 29 to 89 days of age, admitted with rectal temperature > 38oC without a focus of infection. the results of the sepsis evaluation on admission were recorded. SBI included all cases of occult bacteremia, urinary tract infection, bacterial meningitis, pneumonia, bacterial gastroenteritis and infections of the soft tissues and bones. of the 408 infants studied, 103 (25.2%) had SBI. Platelet count was significantly higher in infants with SBI compared to those without (median 513000 /mm3 [interquartile range 455,000-598,000/mm3] vs median 398000/mm3; [interquartile range 313,000-463,000/mm3]; P<0.001). Thrombocytosis had only moderate ability in predicting SBI (area under the curve: 0.74, 95 % CI 0.70-0.79). The combination of platelet count >450,000/mm3, WBC >15,000/mm3, Creactive protein >2 mg/dL, and pyuria >10 WBC/hpf would lead to misclassification of 4 infants with SBI (3.9% of SBIs; negative likelihood ratio 0.08). reactive thrombocytosis was a frequent finding in young infants with SBI. Thrombocytosis >450,000 cells/mm3, in combination with leucocytosis, elevated CRP and pyuria, may help in early recognition of febrile young infants at risk for SBI.

Extreme leucocytosis and the risk of serious bacterial infections in febrile children

ObjectiveTo determine the clinical significance of extreme leucocytosis (white blood cell (WBC) count >25 000/mm3) as a predictor of serious bacterial infection (SBI) in children.Patients and methodsA retrospective case–control study...