Rate Of Serious Bacterial Infections Research Articles

The Risk of Serious Bacterial Infection in Febrile Infants 0-90 Days of Life With a Respiratory Viral Infection.

Molecular diagnostic methods enhance the sensitivity and broaden the spectrum of detectable respiratory viruses in febrile infants ≤90 days of life. We describe the occurrence of respiratory viruses in this population, as well as the rates of serious bacterial infection (SBI) and respiratory viral coinfection with regard to viral characteristics. This was a prospective observational cohort study performed in the emergency department that included previously healthy febrile infants ≤90 days of life. Clinical and historical characteristics were documented, and a respiratory nasal wash specimen was obtained from each patient. This sample was tested for 17 common respiratory pathogens, and a chart review was conducted to ascertain whether the infant was diagnosed with an SBI. In a 12-month period, 67% of the 104 recruited febrile infants were positive for a respiratory virus. The most commonly detected viruses were rhinovirus, respiratory syncytial virus, enterovirus and influenza. The rate of respiratory viral and SBI coinfection was 9% overall, and infants with either a systemic respiratory virus or negative viral testing were 3 times more likely to have an SBI than those with viruses typically restricted to the respiratory mucosa (95% confidence interval: 1.1, 9.7). Respiratory viruses are readily detectable via nasopharyngeal wash in febrile infants ≤90 days of life. With the enhanced sensitivity of molecular respiratory diagnostics, rates of coinfection of respiratory viruses and SBI may be higher than previously thought. Further investigation utilizing molecular diagnostics is needed to guide usage in febrile infants ≤90 days.

Positive Viral Tests in Febrile Young Infants: Do They Matter?

Research Article| March 01 2019 Positive Viral Tests in Febrile Young Infants: Do They Matter? AAP Grand Rounds (2019) 41 (3): 30. https://doi.org/10.1542/gr.41-3-30 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Positive Viral Tests in Febrile Young Infants: Do They Matter?. AAP Grand Rounds March 2019; 41 (3): 30. https://doi.org/10.1542/gr.41-3-30 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: fever, bacterial infection, serious Source: Mahajan P, Browne LR, Levine DA, et al. Risk of bacterial coinfections in febrile infants 60 days old and younger with documented viral infections. J Pediatr. 2018; 203: 86.e2– 91.e2. doi: https://doi.org/10.1016/j.jpeds.2018.07.073Google Scholar Investigators from multiple institutions conducted a secondary analysis of data collected during a large prospective study in febrile infants ≤60 days old to assess the risk of serious bacterial infection (SBI) in patients with a documented viral infection. The original study was conducted by the Pediatric Emergency Care Applied Research Network and included children ≤60 days old, with a temperature >38.0°C, presenting to 1 of 26 EDs. Demographic information, physical examination findings, and laboratory results were collected for enrolled patients. For the current analysis, only study participants who were tested for at least one virus were included. The primary study outcome was the presence of an SBI, including UTI, bacteremia, or bacterial meningitis. The diagnosis of SBI was based on blood, urine, and cerebrospinal fluid culture results. For study patients in whom lumbar puncture was not performed, the absence of bacterial meningitis was confirmed based on telephone contact with the infants’ parents 7 days after the index visit. The rates of any SBI and each individual SBI were compared among viral-positive and viral-negative infants and the risk ratio (RR) calculated; analyses limited to children ≤28 days old and >28 days old were also conducted. Among the 4,788 infants enrolled in the original study, 3,072 (64.3%) had testing for at least one virus. Among these 3,072 infants, 2,945 (95.9%) who also had complete ascertainment for the presence of an SBI were included in the current analyses, of whom 1,200 (48.1%) had a positive test for ≥1 virus. The rate of SBI in viral-positive infants was 3.7% (95% CI, 2.7%–4.9%) compared to 12.7% (95% CI, 11.2%–14.4%) for those who were virus-negative (RR, 3.5; 95% CI, 2.5–4.8). Rates of UTI (2.8% and 10.7%, respectively) and bacteremia (0.8% and 2.9%, respectively) were also significantly lower in viral-positive infants than in viral-negative infants. Bacterial meningitis was diagnosed in 0.4% of viral-positive infants compared to 0.8% in viral-negative infants (RR, 1.9; 95% CI, 0.7%–5.3%). Among infants who were ≤28 days old and those who were >28 days old, the risk of SBI was significantly lower in viral-positive infants (RR, 4.0; 95% CI, 2.4–6.6 and RR, 2.9; 95% CI, 1.9–4.3, respectively). The authors conclude that, although the rate of SBI is lower in febrile infants ≤60 days old who have a documented viral infection than in those who are viral negative, viral-positive infants are still at nonnegligible risk for SBI. Dr Stevenson has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Substantial variation in the evaluation of the young febrile infant exists across pediatric EDs in the United States at both the patient and hospital levels.1 In the present study, viral testing via rapid antigen testing, immunofluorescence,... You do not currently have access to this content.

Risk of Serious Bacterial Infection in Infants Aged ≤60 Days Presenting to Emergency Departments with a History of Fever Only

To compare the risk of serious bacterial infection between infants aged ≤60 days who are febrile in the emergency department (ED) and those who have only a history of fever and are afebrile on arrival to the ED. In this secondary analysis of a multicenter prospective study using data collected between December 2008 and May 2013, we compared the rate of serious bacterial infection (urinary tract infection [UTI], bacteremia, and/or bacterial meningitis) between infants who have a history of fever but are afebrile on arrival to the ED and those with fever documented in the ED (rectal temperature ≥38.0 °C) using relative risk (RR) with 95% CI. Stratified analyses were performed for age (≤28 and 29-60 days) and serious bacterial infection type. Infants born prematurely and those with a clinical focal infection or serious illness were excluded. A total of 3825 infants (mean age, 35.2 days; 56.9% male) were included. Of the 1233 (32.2%) who were afebrile in the ED, 108 (8.8%) had a serious bacterial infection (UTI, n = 94 [7.6%]; bacteremia, n = 19 [1.5%]; bacterial meningitis, n = 8 [0.6%]). Of the 2592 infants (67.8%) who were febrile in the ED, 331 (12.8%) had a serious bacterial infection (UTI, n = 285 [11.0%]; bacteremia, n = 61 [2.4%]; bacterial meningitis, n = 17 [0.7%]). The RR for serious bacterial infection for afebrile vs febrile infants was 0.68 (95% CI, 0.56-0.84). A lower risk of serious bacterial infection was also seen among afebrile vs febrile infants aged ≤28 days (RR, 0.69; 95% CI, 0.52-0.93) and age 29-60 days (RR, 0.67; 95% CI, 0.50-0.89). The prevalence of serious bacterial infection is lower in infants aged ≤60 days with a history of fever compared with those who are febrile on arrival to the ED. The small risk reduction in this group is unlikely to alter decision making.

Risk of Bacterial Coinfections in Febrile Infants 60 Days Old and Younger with Documented Viral Infections

ObjectiveTo determine the risk of serious bacterial infections (SBIs) in young febrile infants with and without viral infections.Study designPlanned secondary analyses of a prospective observational study of febrile infants 60 days of age or younger evaluated at 1 of 26 emergency departments who did not have clinical sepsis or an identifiable site of bacterial infection. We compared patient demographics, clinical, and laboratory findings, and prevalence of SBIs between virus-positive and virus-negative infants.ResultsOf the 4778 enrolled infants, 2945 (61.6%) had viral testing performed, of whom 1200 (48.1%) were virus positive; 44 of the 1200 had SBIs (3.7%; 95% CI, 2.7%-4.9%). Of the 1745 virus-negative infants, 222 had SBIs (12.7%; 95% CI, 11.2%-14.4%). Rates of specific SBIs in the virus-positive group vs the virus-negative group were: UTIs (33 of 1200 [2.8%; 95% CI, 1.9%-3.8%] vs 186 of 1745 [10.7%; 95% CI, 9.2%-12.2%]) and bacteremia (9 of 1199 [0.8%; 95% CI, 0.3%-1.4%] vs 50 of 1743 [2.9%; 95% CI, 2.1%-3.8%]). The rate of bacterial meningitis tended to be lower in the virus-positive group (0.4%) than in the viral-negative group (0.8%); the difference was not statistically significant. Negative viral status (aOR, 3.2; 95% CI, 2.3-4.6), was significantly associated with SBI in multivariable analysis.ConclusionsFebrile infants ≤60 days of age with viral infections are at significantly lower, but non-negligible risk for SBIs, including bacteremia and bacterial meningitis.

Febrile Infant Hospitalizations: When Is the Right Time to Discharge?

Early in their training, pediatricians come to grips with a scary fact about young febrile infants <3 months of age: they can be sick without looking sick.1–3 Until the early 1990s, both well- and ill-appearing young febrile infants were managed conservatively, with the same cookbook strategy: hospitalization for 48 to 72 hours on empirical parenteral antibiotics as urine, blood, and spinal fluid cultures marinated.4,5 Pediatric house staff became proficient at spinal taps but also learned that most infants had cultures that tested negative. This “rule out sepsis” recipe clearly subjected many infants to the risks and costs of unnecessary hospitalization and treatment.6 At least 2 questions ensued: which infants could be spared hospitalization? And, if an infant was hospitalized, when could she or he be safely discharged? With regard to the first question, in 2012, the US Agency for Healthcare Research and Quality published a comprehensive review of the myriad of approaches to this conundrum,7 and most are familiar with the current state of affairs.8 First, pediatric trainees still learn the algorithms developed decades ago in Boston,9 Milwaukee,10 Philadelphia,11 and Rochester,12 which teased out a subpopulation of “low-risk” febrile infants who might safely be spared tests, antibiotics, and/or hospitalization. In other studies, authors supported intramuscular ceftriaxone and close follow-up as an alternative to hospitalization for selected infants 28 to 90 days of age.13 Second, despite changes in bacteriology, such as the virtual disappearance of Listeria and Haemophilus influenzae , and the impressive reduction in group B streptococcal and pneumococcal infections,14,15 the overall ball park rates of serious bacterial infection in young febrile infants remain stubbornly unchanged: 5% to 10% have a …

The impact of paediatric antimicrobial stewardship programmes on patient outcomes.

Although there has been an unprecedented global effort to reduce the spread of antimicrobial resistance, little emphasis has been placed on children. This review aims to evaluate the impact of paediatric antimicrobial stewardship programmes as well as providing a practical approach for effectively implementing them in community-based settings and in hospitals. Although rates of serious bacterial infection are low in children, the rates of antimicrobial use and resistance are comparable with adults. Different strategies are required to implement antimicrobial stewardship in community-based settings compared to in hospitals. Nationally coordinated, whole-system approaches have achieved long-term, sustainable reductions in antimicrobial prescribing, as well as reductions in resistance rates at population level, with no evidence of an increase in rate of serious infection or bacterial complications. Antimicrobial stewardship programmes in neonates and children have unique characteristics and issues. There is currently no consensus on how to measure consumption of antimicrobials in neonates and children. This is a research priority. Benchmarking and clinical networks in neonates and paediatrics are important to share practice and drive best use of antimicrobials.

Etiology and Causative Pathogens of Febrile Neonates

Background: Evaluation and treatment of febrile neonates varied widely among the different centers. The prevalence of serious bacterial infection (SBI) is high in neonates; thus, most experts would support the approach of a full sepsis evaluation and hospitalization. We aimed to evaluate the clinical and laboratory characteristics of febrile neonate less than 28 days of age and describe the incidence of SBI in febrile neonates. Methods: This prospective observational cohort study was include neonates with a rectal temperature of ≥ 38°C who admitted to NICU between 2011 and 2015. Demographic information, physical examination findings, laboratory test results, and final diagnosis were recorded and compared to identifıedas serious bacterial infection (SBI) or no-SBI. For determination of SBI; CRP and WBC cut-off values were calculated by receiver operating characteristic curve analysis. Results: 328 infants were included the study. The overall rate of SBI was 38.4%. The common final diagnosis were found unknown reason (43.6%), urinary tract infection (15.5%), dehydration (14%), and bacteremia (5.8%). The most common bacterial growth in culture Escherichia coli in 19 cases and Methicillin-Resistant Coagulase-Negative Staphylococci in 16 cases detected. A significant cut-off value could not be determined for CRP (AUC: 0.664) 95% CI: 0.604-0.723 and WBC (AUC: 0.535) 95% CI: 0.472-0.597. Conclusion: Gram positive pathogens were more common in febrile neonates than older febrile infants. A reliable cutoff value for CRP and WBC for detection SBI in neonatal period could not be determined.

Creación de un modelo probabilístico de diagnóstico de infección bacteriana grave en lactantes febriles de 0 a 3 meses de vida

Fever is a common cause of paediatric admissions in emergency departments. An aetiological diagnosis is difficult to obtain in those less than 3 months of age, as they tend to have a higher rate of serious bacterial infection (SBI). The aim of this study is to find a predictor index of SBI in children under 3 months old with fever of unknown origin.A study was conducted on all children under 3 months of age with fever admitted to hospital, with additional tests being performed according to the clinical protocol. Rochester criteria for identifying febrile infants at low risk for SBI were also analysed. A predictive model for SBI and positive cultures was designed, including the following variables in the maximum model: C-reactive protein (CRP), procalcitonin (PCT), and meeting not less than four of the Rochester criteria.A total of 702 subjects were included, of which 22.64% had an SBI and 20.65% had positive cultures. Children who had SBI and a positive culture showed higher values of white cells, total neutrophils, CRP and PCT. A statistical significance was observed with less than 4 Rochester criteria, CRP and PCT levels, an SBI (area under the curve [AUC] 0.877), or for positive cultures (AUC 0.888). Using regression analysis a predictive index was calculated for SBI or a positive culture, with a sensitivity of 87.7 and 91%, a specificity of 70.1 and 87.7%, an LR+ of 2.93 and 3.62, and a LR- of 0.17 and 0.10, respectively.The predictive models are valid and slightly improve the validity of the Rochester criteria for positive culture in children less than 3 months admitted with fever.

Efficacy and Safety of Human Intravenous Immunoglobulin 10% (Panzyga\xae) in Patients with Primary Immunodeficiency Diseases: a Two-Stage, Multicenter, Prospective, Open-Label Study

PurposeTo assess the efficacy and safety of panzyga® (intravenous immunoglobulin 10%) in preventing serious bacterial infections (SBIs) in patients with primary immunodeficiency diseases (PIDs), a prospective, open-label, multicenter, phase 3 study and an open-label extension study were undertaken.MethodsInitially, the study drug (infusion rate ≤0.08 mL/kg/min) was administered at intervals of 3 or 4 weeks for 12 months, followed by 3 months of panzyga® at infusion rates increasing from 0.08 to 0.14 mL/kg/min. The primary endpoint in the main study was the rate of SBIs per patient-year on treatment. Secondary outcomes included non-serious infections, work/school absence, episodes of fever, quality of life, and adverse events (AEs).ResultsThe main study enrolled 51 patients (35% female, mean age 26.8 years), with 21 participating in the extension study. The rate of SBIs per patient-year was 0.08 in the total population; there were four SBIs in the 4-weekly treatment group (2/30 patients) and none in the 3-weekly group (n = 21). Compared with 4-weekly treatment, 3-weekly treatment was associated with a higher rate of upper respiratory tract infections (RTIs), ear infections, and work/school absences, but a lower rate of lower RTIs and fever. Treatment was generally well tolerated; no AE led to treatment withdrawal or death.ConclusionsOverall, the use of panzyga® in patients with antibody-deficient PID was associated with a low rate of AEs and was effective in preventing SBIs, exceeding US FDA and European Medicines Agency recommendations for efficacy.

Significance of extreme leukocytosis in evaluation of febrile children aged 3-36 months: A single center experience

Background: Emergency department evaluation of young febrile children often includes measurement of white blood cell (WBC) count. Although a high WBC count is associated with an increased likelihood of infection, the clinical significance of extreme leukocytosis (EL) (a WBC count of ≥25,000/mm 3 ), has not been well studied. Objective: The aim of this study is to study the correlation between the level of WBC and the cause of fever in febrile children and to assess if WBC level helpful in predicting the seriousness of febrile illness. Patients and Methods: A cross-sectional case series study conducted over 5 months from August 01 to December 31, 2015, in the emergency department at child central teaching hospital in Baghdad city in Iraq. The study was evaluating children aged 3-36 months admitted to the emergency department for fever. WBC count was done either manually or a complete blood count by automated hematologic analyzer. Results: Of those 129 febrile children were enrolled in this study, 42 patients with EL were identified and compared with 87 patients with moderate leukocytosis (ML). Pneumonia was the only diagnosis found to be significantly higher in EL group 17 cases (40.5%) versus 15 cases (17.2%) in ML group with P value (0.004). Meningitis was higher in patient with ML with P value (0.03). Finally, EL was associated with higher rates of admission to hospital (P Conclusions: The presence of EL indicates a higher risk of having pneumonia. The degree of leukocytosis (extreme or moderate) does not affect the rates of serious bacterial infection.

Easing the wheeze.

Easing the wheeze.

The Changing Epidemiology of Serious Bacterial Infections in Young Infants

Management of febrile young infants suspected of having serious bacterial infections has been a challenge for decades. The impact of changes in prenatal screening for Group B Streptococcus and of infant immunizations has received little attention in population-based studies. This study analyzed all cultures of blood, urine and cerebrospinal fluid obtained from full-term infants 1 week to 3 months of age, who presented for care at Kaiser Permanente Northern California during a 7-year period utilizing electronic medical records. A total of 224,553 full-term infants were born during the study period. Of 5396 blood cultures, 129 bacteremic infants were identified (2%). Of 4599 urine cultures, 823 episodes of urinary tract infection (UTI) were documented in 778 infants (17%). Of 1796 CSF cultures, 16 infants had bacterial meningitis (0.9%). The incidence rate of serious bacterial infections (bacteremia, UTI and meningitis) and febrile serious bacterial infections was 3.75 and 3.1/1000 full-term births, respectively. Escherichia coli was the leading cause of bacteremia (78), UTI (719) and bacterial meningitis (7). There were 23 infants with Group B Streptococcus bacteremia including 6 cases of meningitis and no cases of Listeria infection. Nine percentage of infants had multiple sites of infection; 10% of UTIs were associated with bacteremia and 52% of bacteremia was associated with UTI. Compared with earlier studies, UTIs now are found significantly more often than bacteremia and meningitis with 92% of occult infections associated with UTIs. These data emphasize the importance of an urinalysis in febrile infants.

Long-term efficacy, safety, and tolerability of Hizentra® for treatment of primary immunodeficiency disease

Hizentra(®) (20% subcutaneous immunoglobulin [SCIG]) was administered to subjects with primary immunodeficiency disease in two extension studies in the EU and US to assess long-term efficacy and tolerability. Subjects (aged 4-69 years) were treated for 148 weeks in the EU (N = 40; 5405 infusions) and 87 weeks in the US (N = 21; 1735 infusions). Weekly doses were 116.0 mg/kg (EU) and 193.2 mg/kg (US); IgG levels were 7.97 g/L (EU) and 11.98 g/L (US). Annualized rates of serious bacterial infections were 0.05 infections/subject/year (EU) and 0.06 infections/subject/year (US). Rates of any infection were 3.33 infections/subject/year (EU) and 2.38 infections/subject/year (US). The rate of bronchopulmonary infections was higher in the EU study. No treatment-related serious AEs occurred; no subject discontinued because of treatment-related AEs. Self-administered Hizentra afforded sustained effective protection from infections and favorable tolerability during an extended treatment period of up to 3 years.

Post‐marketing observational study on 5% intravenous immunoglobulin therapy in patients with secondary immunodeficiency and recurrent serious bacterial infections

Secondary hypogammaglobulinemia is one of the factors responsible for the increased susceptibility to infection in patients with chronic lymphocytic leukemia (CLL). This study assessed the therapeutic results, concomitant medication and tolerance of administering 5% intravenous immunoglobulin, secondary immunodeficiency and recurrent serious bacterial infections. A single center, post-marketing, observational clinical study was performed on 10 patients with a variety of hematological malignancies (CLL, follicular non-Hodgkin lymphoma, IgM-secreting immunocytoma, IgA plasmacytoma and myelodysplastic syndrome/non-Hodgkin lymphoma) who had been infused with IVIG from June 1994 to May 2009. The clinical benefit of IVIG was assessed by comparing the incidence of bacterial infections before and after starting this therapy. Plasma immunoglobulin concentrations and relevant hematological variables were recorded. For safety assessment, adverse events were monitored. The standard IVIG dosage was approximately 0.35 g/kg body weight every 3-4 weeks. Most patients had normal IgG trough values of >600 mg/dL during the IVIG treatment period. The rate of bacterial infections was reduced from 2.4 per patient in the 3 months before IVIG to 0.7 (0-1.5) per patient per year during IVIG treatment. All patients received concomitant medication, mainly anticancer and anti-anemia therapy (100%). No serious adverse events related to IVIG were observed. The frequency of at least one minor adverse reaction was 1.44% (8/556 infusions). In conclusion, the investigated IVIG preparation was well tolerated and clinically beneficial in reducing the long term rate of serious bacterial infections in patients receiving concomitant treatment for malignant diseases.

Infectious Complications in Juvenile Idiopathic Arthritis

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood. Many questions regarding the risk of infection associated with JIA and with the immunosuppressant therapeutic agents commonly used to treat JIA are currently unanswered. It appears likely that JIA itself increases the background rate of serious bacterial infections, irrespective of immunosuppressant use. The available evidence suggests that treatment with methotrexate or tumor necrosis factor inhibitors only modestly increases the risk of serious infections and may not increase the risk at all. Opportunistic infections are very uncommon among children with JIA, but they likely occur at an increased rate compared to children without JIA. Intra-articular glucocorticoid injections almost never result in infectious complications in the treatment of JIA when performed carefully. Additional controlled studies of the risks of infection among children with JIA are needed, particularly comparative studies of newer therapeutic agents.

Is 15 Days an Appropriate Cut-off Age for Considering Serious Bacterial Infection in the Management of Febrile Infants?

Febrile infants <3 months of age have a greater risk for serious bacterial infection (SBI). The risk is inversely correlated with age. Most protocols recommend admitting to hospital all febrile infants <28 days of age. However, as the prevalence of SBI is not homogenous in this age group, some authors have considered decreasing this cut-off age, allowing ambulatory management of selected patients meeting low-risk criteria. To determine whether 15 days is a suitable cut-off age for different approaches to the management of infants with fever. Cross-sectional descriptive study of infants <3 months of age with fever without a source seen between September 1, 2003 and August 30, 2010 in the pediatric emergency department of a tertiary teaching hospital. All infants <3 months of age with fever without a source (≤ 38 °C) were included. The following data were collected: age, sex, temperature, diagnosis, management in pediatric emergency department, and outcome. Data were collected for 1575 infants; of whom, 311 (19.7%, 95% confidence intervals [CI]: 17.7-21.7) were found to have an SBI. The rate of SBI in the patients who were 15 to 21 days of age was 33.3% (95% CI: 23.7%-42.9%), similar to that among infants who were 7 to 14 days of age (31.9%, 95% CI: 21.1%-42.7%) and higher than among those older than 21 days of age (18.3%, 95% CI: 16.3-20.3%). Febrile infants 15 to 21 days of age had a rate of SBI similar to younger infants and higher than older age infants. It is not appropriate to establish the approach to management of infants with fever based on a cut-off age of 2 weeks.

Efficacy, Safety and Pharmacokinetics of a Novel Subcutaneous Immunoglobulin, Evogam®, in Primary Immunodeficiency

This phase III, open-label, multi-centre study investigated the efficacy, safety, pharmacokinetics and quality of life impact of Evogam(®), a new chromatographically fractionated 16% subcutaneous immunoglobulin, utilising a 1:1 dose transition ratio from previous immunoglobulin therapy. Thirty-five previously treated patients with primary immunodeficiency received weekly Evogam over 36 weeks. Primary endpoints were rate of serious bacterial infections (SBIs) and steady-state serum immunoglobulin G (IgG) trough concentrations. No SBIs were reported during the study. Evogam produced significantly higher mean trough IgG concentrations with 1:1 dose conversion compared to previous immunoglobulin treatment (8.94 versus 8.27 g/L, p = 0.0063). Evogam was efficacious in the prevention of infections and maintenance of trough levels using a 1:1 dose conversion. It was well tolerated with no withdrawals due to adverse events and was preferred to IVIg by the majority of patients.

Occult Serious Bacterial Infection in Infants Younger Than 60 to 90 Days With Bronchiolitis

To summarize the risk of occult serious bacterial infection in the youngest febrile infants presenting with either clinical bronchiolitis or respiratory syncytial virus infection. We performed a systematic search of the Medline database for studies reporting rates of serious bacterial infection in infants younger than 90 days with clinical bronchiolitis and/or respiratory syncytial virus infection. Studies reporting on cultures performed at the time of presentation to care and providing a denominator, ie, total number of each type of culture obtained, were analyzed. Admission for bronchiolitis. Age-specific rates of urinary tract infection, bacteremia, and meningitis were extracted. The weighted rate of urinary tract infections in the youngest infants in the 11 studies analyzed was 3.3% (95% confidence interval, 1.9%-5.7%). No case of bacteremia was reported in 8 of 11 studies. No case of meningitis was reported in any of the studies. Summary statistics for meningitis and bacteremia are not provided because of an excess of zero events in these samples. A screening approach to culturing for serious bacterial infections in febrile infants presenting with bronchiolitis or respiratory syncytial virus infection is very low yield. The rate of urine cultures positive for bacteria remains significant, though asymptomatic bacteriuria may confound these results.

Improved Quality of Life, Immunoglobulin G Levels, and Infection Rates in Patients with Primary Immunodeficiency Diseases during Self-Treatment with Subcutaneous Immunoglobulin G

Primary immunodeficiency diseases (PIDDs) include a large class of genetically heterogeneous disorders which predispose patients to significant risk of serious and chronic/recurrent infections, as well as reduced quality of life (QoL). Intravenous immunoglobulin (IVIG) therapy improves the well being of PIDD patients; however, the need for venous access and potentially severe side effects frequently require administration in medical facilities. We evaluated the long-term (12-month) experience with home-based self infusions of subcutaneous immune globulin (SCIG) in patients with PIDD on health-related QoL, rates of serious bacterial infections, and all other infections. Adults (n = 42) and children (n = 9) with PIDD, previously treated with clinic-based IVIG, were trained to self administer SCIG at home. QoL (SF-36(R) and CHQ-PF50 questionnaires), serious bacterial infections, serum immunoglobulin G (IgG) levels, overall infections, and incidence of adverse events were recorded at predetermined intervals. All patients had improved perceptions of general health (adults P = 0.047, children P = 0.037). Adults also had marked improvement in the bodily pain and vitality assessments, and parents had improved perceptions of personal and family activities. Serum IgG levels were maintained at mean levels 25% higher than previous troughs on IVIG. There were 162 infections overall for an annual rate of 3.42/patient, but only 1 serious bacterial infection was observed (0.03/patient/yr). An average of 4.5 days/yr was missed from work or school per patient. Home SCIG therapy was safe and led to improved perceptions of general health, higher serum IgG levels, and very low rates of infections and days missed from work/school.

Changing Epidemiology of Serious Bacterial Infections in Febrile Infants without Localizing Signs

ObjectiveHistorically, management of infants with fever without localizing signs (FWLS) has generated much controversy, with attempts to risk stratify based on several criteria. Advances in medical practice may have altered the epidemiology of serious bacterial infections (SBIs) in this population. We conducted this study to test the hypothesis that the rate of SBIs in this patient population has changed over time.Patients and MethodsWe performed a retrospective review of all infants meeting FWLS criteria at our institution from 1997–2006. We examined all clinical and outcome data and performed statistical analysis of SBI rates and ampicillin resistance rates.Results668 infants met criteria for FWLS. The overall rate of SBIs was 10.8%, with a significant increase from 2002–2006 (52/361, 14.4%) compared to 1997–2001 (20/307, 6.5%) (p = 0.001). This increase was driven by an increase in E. coli urinary tract infections (UTI), particularly in older infants (31–90 days).ConclusionsWe observed a significant increase in E. coli UTI among FWLS infants with high rates of ampicillin resistance. The reasons are likely to be multifactorial, but the results themselves emphasize the need to examine urine in all febrile infants <90days and consider local resistance patterns when choosing empiric antibiotics.