Serious Bacterial Infections In Children Research Articles

Protocol for the diagnostic performance of C reactive protein, procalcitonin and interleukin-6 for serious bacterial infections among children ≤36 months old presenting with fever without source: a systematic review and meta-analysis

IntroductionThe management of fever without source in children ≤36 months old remains a diagnostic challenge as the underlying aetiologies can vary from self-limiting viral infections to serious bacterial infections (SBIs)....

Are children with prolonged fever at a higher risk for serious illness? A prospective observational study

ObjectivesTo describe the characteristics and clinical outcomes of children with fever ≥5 days presenting to emergency departments (EDs).DesignProspective observational study.Setting12 European EDs.PatientsConsecutive febrile children <18 years between January 2017 and...

Viremia as a predictor of absence of serious bacterial infection in children with fever without source

Most children with fever without source (FWS) require diagnostic laboratory tests to exclude a serious bacterial infection (SBI), often followed by admission and empirical antibiotics. As febrile children with a viral infection are less likely to have a SBI, identifying patients with systemic viral infection could contribute to exclude SBI. We evaluated whether the presence of virus in the blood could be used as a biomarker to rule out SBI. Children < 3 years old with FWS were prospectively enrolled and had real-time (reverse-transcription) PCR performed on the blood for adenovirus, enterovirus, parechovirus, and HHV6. 20/135 patients had SBI, and in 47/135, at least one virus was detected in the blood. Viremia had a higher sensitivity and negative predictive value (90% and 96%) to rule out SBI compared to CRP (65% and 93%) and PCT (55% and 90%). The odds ratio (OR) for the presence of SBI among non-viremic patients was 5.8 (p = 0.0225), compared to 5.5 for CRP ≥ 40 mg/l (p = 0.0009) and 3.7 for PCT ≥ 0.5 ng/mL (0.0093). This remained significant after adjusting for CRP and PCT (OR 5.6 and 5.9, respectively; p = 0.03 for both). Area under the ROC curve for CRP and PCT were 0.754 and 0.779, respectively, but increased to 0.803 and 0.832, respectively, when combined with viremia.Conclusion: The presence of viremia had a better performance than commonly used biomarkers to rule-out SBI and could potentially be used in conjunction with CRP and/or PCT in the evaluation of children with FWS. Larger studies should evaluate the role of point-of-care testing of viruses by (revere-transcription) PCR in the plasma in management algorithms of children with FWS.What is Known:• Most children with FWS have a viral infection, but up to 15% have a SBI; most require laboratory tests, and many admission and empirical antibiotics.• Children with a viral infection are less likely to have a SBI.What is New:• Children with a systemic viral infection are less likely to have an SBI.• Viremia is a better predictor of absence of SBI than commonly used biomarkers and could potentially be used in conjunction with CRP and/or PCT in the evaluation of children with FWS.

Potential and promising marker for serious bacterial infections in children: Delta neutrophil index.

This study aimed to evaluate the usefulness and accuracy of the delta neutrophil index (DNI), an index expressing the number of immature granulocytes as a proportion of the total, as an inflammatory marker in predicting serious bacterial infections (SBIs). Paediatric patients admitted to our hospital with fever were divided into four groups: SBI, non-SBI, COVID-19 and control group. White blood cell count, absolute neutrophil count, C-reactive protein and the DNI were recorded, and their accuracy in predicting SBI was evaluated. Mean DNI was 4.96 ± 8.38 in the SBI group (150 patients), 0.67 ± 1.68 in the non-SBI group (397 patients), 0.29 ± 0.99 in the COVID-19 group (112 patients) and 0.14 ± 0.21 in the control group (102 patients). The DNI wassignificantly higher in the SBI group compared with the non-SBI (P < 0.001); the non-SBI group also had higher levels than the COVID-19 group (P=0.005). One percent increase in the DNI increased the SBI rate 1.36 times (odds ratio 1.36 (95% confidence interval 1.23-1.49), P <0.001). Based on the determined cut-off value (>2.5%), the DNI (odds ratio 6.27 (95% confidence interval 3.85-10.21), P <0.001) significantly predicted SBIs with 90.4% specificity and 47.7% sensitivity. SBIs in childrenare associated with an increase in DNI levels. Compared to other biomarkers, the DNI had higher specificity in predicting SBIs. The DNI may also be usefulin differentiating bacterial and non-bacterial infections in individualclinical syndromes. Currently, there is no evidence that serum DNI aids indifferentiating COVID-19 and upper respiratory tract infection.

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.

Cost-effectiveness of procalcitonin for detection of serious bacterial infections in children presenting with fever without source

IntroductionProcalcitonin (PCT) offers better specificity than C-reactive protein (CRP) to detect SBI. However, their cost limited their use and routine application. The objective of this work is to determine the cost-effectiveness of PCT against CPR or Rochester scale in infants between 1 and 3 months from the perspective of the third payer in Colombia.MethodsA Monte Carlo simulation was performed with a hypothetical cohort of 10,000 patients with fever without focus (FWS) between 1 to 3 months, to estimate the number of cases correctly diagnosed for each test and the associated costs with each test.ResultsThe test with the highest number of correctly diagnosed cases was PCT 79%, followed by C-reactive protein 75%, and the Rochester scale 68%. The test with the lowest cost per patient was PCT $645 (95% CI US$646-US$645) followed by C-reactive protein U$ 653 (95% CI US$655-$645) and Rochester scale US$804 (95% CI US$807-US$804). This position of dominance of PCT eliminated the need to calculate an incremental cost effectiveness ratio.ConclusionsPCT is the most cost-effective strategy for the detection of IBS in infants with FWS. These results should be interpreted within the clinical context of the patient and not as a single method for therapeutic decision-making.

C-Reactive Protein With Procalcitonin as a Marker of Occult Bacterial Infection in Fever Without a Focus

Introduction: Fever without a focus constitutes a major problem in children in the age group of three months to 36 months. Majority have viral infections but around 1.6 - 2% can have occult serious bacterial infection which needs early identification and treatment. The study was done to evaluate combination of CRP with Procalcitonin (PCT) as a marker of SBI in children (Three months - 36 months) with fever without focus in comparison with only PCT or CRP done separately. Methods: In this hospital based explorative study, 31 children between three months to 36 months of age with fever without any localising signs were enrolled. Relevant investigations were done to diagnose or rule out serious bacterial infection. Cut off of &gt; 10 mg/dl for CRP and &gt; 0.5 ng/ml for PCT was considered. Appropriate statistical analysis was done. Results: Among 31 recruited cases, 14 had occult serious bacterial infection with urinary tract infection being the most common cause. The combination PCT with CRP had sensitivity of 78.5%, specificity of 100%, and positive predictive value of 100% and negative predictive value of 85%. Diagnostic accuracy was 90.32% which did not have any statistically significant difference compared to PCT alone but significant compared to CRP alone. Conclusions: Combining CRP with procalcitonin did not have any added advantage over procalcitonin alone but combination of CRP and PCT and PCT alone is useful in detecting occult serious bacterial infections in children with fever without focus compared to CRP alone.

Ceftaroline Fosamil for Treatment of Pediatric Complicated Skin and Soft Tissue Infections and Community-Acquired Pneumonia.

Community-acquired pneumonia (CAP)/community-acquired bacterial pneumonia (CABP) and complicated skin and soft tissue infection (cSSTI)/acute bacterial skin and skin structure infection (ABSSSI) represent major causes of morbidity and mortality in children. β-Lactams are the cornerstone of antibiotic treatment for many serious bacterial infections in children; however, most of these agents have no activity against methicillin-resistant Staphylococcus aureus (MRSA). Ceftaroline fosamil, a β-lactam with broad-spectrum in vitro activity against Gram-positive pathogens (including MRSA and multidrug-resistant Streptococcus pneumoniae) and common Gram-negative organisms, is approved in the European Union and the United States for children with CAP/CABP or cSSTI/ABSSSI. Ceftaroline fosamil has completed a pediatric investigation plan including safety, efficacy, and pharmacokinetic evaluations in patients with ages ranging from birth to 17 years. It has demonstrated similar clinical and microbiological efficacy to best available existing treatments in phase III–IV trials in patients aged ≥ 2 months to < 18 years with CABP or ABSSSI, with a safety profile consistent with the cephalosporin class. It is also approved in the European Union for neonates with CAP or cSSTI, and in the US for neonates with ABSSSI. Ceftaroline fosamil dosing for children (including renal function adjustments) is supported by pharmacokinetic/pharmacodynamic modeling and simulations in appropriate age groups, and includes the option of 5- to 60-min intravenous infusions for standard doses, and a high dose for cSSTI patients with MRSA isolates, with a ceftaroline minimum inhibitory concentration of 2–4 mg/L. Considered together, these data suggest ceftaroline fosamil may be beneficial in the management of CAP/CABP and cSSTI/ABSSSI in children.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40272-021-00468-w.

Prevalence of Serious Bacterial Infections in Children with Sickle Cell Disease at King Abdulaziz Hospital, Al Ahsa.

ObjectiveThe main aim was to report the prevalence and severity of serious bacterial infections (SBI) in children with sickle cell disease at King Abdulaziz Hospital (KAH), Al Ahsa, Saudi Arabia, to aid in determining whether outpatient management of such cases is appropriate.MethodsWe conducted a retrospective chart review of febrile children less than 14 years of age admitted with sickle cell disease 2005 through 2015.ResultsDuring 320 admissions, 25 children had SBIs (8%) including pneumonia (n=11), osteomyelitis (n=8), bacteremia (n=3, all with Salmonella species) and UTI (n=3). All recovered uneventfully.ConclusionIt appears that in the current era, less than 10% of febrile children with sickle cell disease in our center are diagnosed with an SBI. Over 11 years, there were no sequelae or deaths from SBI. Given these excellent outcomes, outpatient ceftriaxone should be considered for febrile well-appearing children with sickle cell disease if they have no apparent source and parents are judged to be reliable.

Clinical characteristics of pediatric febrile urinary tract infection in Japan

BackgroundFebrile urinary tract infection (fUTI) is the most common serious bacterial infection in children. Despite this, there have been no studies examining the clinical features of pediatric fUTI in Japan. The purpose of this study was to describe the clinical characteristics of fUTI in Japanese children. MethodsA multicenter, retrospective, observational study was conducted at 21 hospitals in Japan. Children under the age of 15 years who were diagnosed with fUTI between 2008 and 2017 were included. The diagnostic criteria were a temperature over 38 °C and the presence of a single bacterial pathogen in urine culture. Patient characteristics were obtained from medical records. ResultsIn total, 2,049 children were included in the study. The median age was 5 months, and 59.3% were male. It was found that 87.0% of the males and 53.2% of the females were under 1 year of age. The main causative pathogens identified were Escherichia coli and Enterococcus spp., accounting for 76.6% and 9.8% of infections, respectively. ConclusionsThere was a male predominance of fUTI in Japanese children, particularly in infants. Enterococcus spp. were the second most frequent causative pathogen; therefore, Gram staining of urine samples is strongly recommended before initiating antibiotic therapy.

Akut Odağı Olmayan Ateş Tanısı Alan Çocuklarda Klinik ve Laboratuvar Bulguların Ciddi Bakteriyel Enfeksiyonu Öngörmedeki Değerlerinin Araştırılması

Objective: Fever is among most common causes of admission to hospital in childhood. In 20% of febrile infants and children, no focus can be identified by physical examination and this group is defined as “acute fever without a focus” (AFWF). Bacteremia (5%), and serious bacterial infection (15%) is determined in of children with AFWF. Clinical scales and laboratory tests are used to detect the risk of occult bacteremia and serious bacterial infection in children with AFWF This study aimed to determine relation between biochemical indicators and YALE Observation Scale, besides, rates of clinical scales and biochemical indicators predicting serious bacterial infections, in 3-36 months children with AFWF. Material and Methods: This study was performed prospectively, in 77 cases, between 3-36 months of AFWF. Low risk criteria was evaluated by performing YALE Observation Scale in children. Complete blood count, absolute neutrophil count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin 6, procalcitonin, urine analysis, chest x-ray, cerebrospinal fluid (CSF) examination; blood, urine and CSF cultures were obtained. Results: The mean age of the patients was 11.0 (4-36) months, 64.9% (n= 50) were boys. Most commonly AFWF recovered in patients (35.0%), and urinary tract infection was diagnosed (32.5%). Severe bacterial infection was determined in 44.2%. When patient groups with and without severe bacterial infection were compared, white blood count, ESH, CRP, and procalcitonin were significantly higher in severe bacterial infection (p&lt; 0.05). Erythrocyte sedimentation rate had highest specificity (87.5%) in discriminating between groups with and without severe bacterial infection. Conclusion: In conclusion, AFWF mostly recovered in children at 3-36 months, and urinary tract infection was common cause. White cell count, ESR, CRP and procalcitonin were found valuable in predicting serious bacterial infection. Further studies are needed to predict interleukin-6 value relevant to serious bacterial infection.

Akut Odağı Olmayan Ateş Tanısı Alan Çocuklarda Klinik ve Laboratuvar Bulguların Ciddi Bakteriyel Enfeksiyonu Öngörmedeki Değerlerinin Araştırılması

Akut Odağı Olmayan Ateş Tanısı Alan Çocuklarda Klinik ve Laboratuvar Bulguların Ciddi Bakteriyel Enfeksiyonu Öngörmedeki Değerlerinin Araştırılması

Fever response to ibuprofen in viral and bacterial childhood infections.

to compare the antipyretic effects of ibuprofen in febrile children with serious bacterial infections (SBI), and children with a presumed viral infection. A prospective cross- sectional study was conducted in a pediatric Emergency department between October 2018 and March 2020 for children aged 3months to 4years with a rectal temperature≥38.5°C. Patients received 10mg/kg of ibuprofen oral suspension. Rectal temperature was measured 60 and 120min after administration. Laboratory and imaging evaluations were performed for each study participant in order to identify serious bacterial infection. Ninety patients were included, of which 18 were diagnosed with serious bacterial infections. There was no significant difference in age, fever at presentation and duration of fever between the groups. No significant difference was noted in body temperature reduction at 60 and 120min after ibuprofen administration (1.09±0.75°C vs 0.89±0.58°C, mean difference-0.12°C, 95% CI -0.54-0.15°C; 1.85±0.53°C vs 1.78±0.83°C, mean difference-0.07°C, 95% CI -0.49-0.36°C, in the SBI and non-SBI groups respectively). Fever response to Ibuprofen administration is not indicative of serious bacterial infections in children under 4years of age. Larger prospective studies are required to define whether the lack of response to Ibuprofen has any impact on the management of febrile children.

Shivering has little diagnostic value in diagnosing serious bacterial infection in children: a systematic review and meta-analysis.

Early diagnosis of serious bacterial infections (SBI) is important for improving outcome of morbidity and mortality in children. A systematic review was conducted to examine if shivering had any value in diagnosing serious bacterial infection. We split our population (0-18 years old) into two categories depending on the presence of a known malignancy. The databases of Medline, Embase, Cinahl, and Web of Science were searched from inception until July 2019. The quality was assessed with the QUADAS-2 tool. Two by two tables were created, extracting the number of true positive (TP), true negative (TN), false positive (FP), and false negative (FN) regarding shivering and SBI, by 2 authors independently. Sensitivity, specificity, likelihood ratios, and their 95% confidence intervals were calculated using the MetaDATA Shiny app. In a population with known malignancy, we found a +LR of 3.47 (95% CI 2.58-4.36) for a serious bacterial infection when shivering was present, implying an increase of 25-30% possibility for a serious bacterial infection. In children without malignancy, diagnostic accuracy of shivering was poor.Conclusion: Shivering is of limited use to diagnose serious bacterial infection in children without malignancy. Nevertheless, in children with known malignancy, it can be useful as an alarm signal. What is Known: • In the NICE guidelines for febrile illness in children, "shivering" is considered as an intermediate risk factor ("amber" sign) for a serious illness. • A systematic literature search conducted in 2007 investigating the correlation between shivering in a febrile child and the presence of a serious bacterial infection could include only one study. What is New: • Based on the results of this systematic review, shivering has little diagnostic value in children without malignancy but can be useful as an alarm sign of serious bacterial infection in children with known malignancy. • In case of absence of shivering, serious bacterial infection cannot be ruled out.

Diagnostic test accuracy of point-of-care procalcitonin to diagnose serious bacterial infections in children

BackgroundThe National Institute for Health and Care Excellence (NICE) have called for research into the role of biomarkers, and specifically procalcitonin (PCT), for the early diagnosis of serious bacterial infections (SBI) in children. The aim of this study was to compare the diagnostic test accuracy of C-reactive protein (CRP) and PCT for the diagnosis of SBI in children.MethodsData was collected prospectively from four UK emergency departments (ED) between November 2017 and June 2019. Consecutive children under 18 years of age with fever and features of possible sepsis and/or meningitis were eligible for inclusion. The index tests were PCT and CRP and the reference standard was the confirmation of SBI.Results213 children were included in the final analysis. 116 participants (54.5%) were male, and the median age was 2 years, 9 months. Parenteral antibiotics were given to 100 (46.9%), three (1.4%) were admitted to a paediatric intensive care unit and there were no deaths. There were ten (4.7%) confirmed SBI. The area under the curve for PCT and CRP for the detection of SBI was identical at 0.70.ConclusionsThere was no difference in the performance of PCT and CRP for the recognition of SBI in this cohort.Trial registrationRegistered at https://www.clinicaltrials.gov (trial registration: NCT03378258) on the 19th of December 2017.

Metabolic acidosis exacerbates pyelonephritis in mice prone to vesicoureteral reflux.

Acute pyelonephritis is a common, serious bacterial infection in children. The prevalence of acute pyelonephritis is due at least in part to vesicoureteral reflux (VUR). Although an association between abnormalities in electrolyte and acid–base balance and pyelonephritis is common in young children, the impact of metabolic acidosis (MA) on progression of acute pyelonephritis is not fully understood. In this study, the effect of MA on pyelonephritis was studied in C3H mouse strains prone to VUR. MA induced by ammonium chloride supplementation in food specifically impaired clearance of urinary tract infection with uropathogenic Escherichia. coli (UPEC‐UTI) in innate immune competent C3H strains (HeOuJ, HeN), whereas kidney UPEC burden in Tlr‐4‐deficient HeJ mice was unaffected. Antibody‐mediated depletion of myeloid cells (monocytes, neutrophil) markedly increased UPEC burden in the bladder and kidney confirming the pivotal role of neutrophils and tissue‐resident macrophages in clearance of UPEC‐UTI. MA concurrent with UPEC‐UTI markedly increased expression of cytokine (TNFα, IL‐1β, IL‐6) and chemokine (CXCL 1, 2, and 5) mRNA in isolated kidney CD cells and kidney neutrophil infiltrates were increased four‐ to fivefold compared to normal, UPEC‐infected mice. Thus, MA intensified pyelonephritis and increased the risk of kidney injury by impairing clearance of UPEC‐UTI and potentiating renal inflammation characterized by an elevated kidney neutrophil infiltrate.

Risk factors for urinary tract infections in children aged 0–36 months presenting with fever without source and evaluated for risk of serious bacterial infections

BackgroundChildren younger than 36 months with fever without a source (FWS) are at risk of serious bacterial infections (SBI). The risk of occult bacteremia (OB) has been greatly reduced in vaccinated children. The aim of this study is to describe the epidemiology of SBI in children with FWS in our setting and to evaluate the performance of our management algorithm. MethodsWe designed a prospective cohort study. We included children aged 0–36 months presenting with FWS in our emergency unit. Demographic and clinical characteristics, investigations, and management procedures were recorded at the time of inclusion. Information on clinical evolution, final diagnosis, and immunization history were obtained after 10 days. Potential predictors of SBI were compared between patients with and without SBI. ResultsBetween October 2015 and September 2017, 173 children were recruited, with a median age of 4.4 months (2.1–1). Of these children, 166 (96%) were up to date with their vaccinations. A total of 47 children (27%) had a final diagnosis of SBI, which were all urinary tract infections (UTI). Presence of chills (odds ratio [OR] 5.6, 95% confidence interval [CI] 1.3–24.3), fever for>2 days (OR 29.1, 95% CI 3.5–243.5), and age<9 months (OR: 45.3, 95% CI: 4.9–415.7) were statistically significant predictors of UTI in a multivariate logistic regression. The sensitivity and specificity of our management algorithm were 100% (95% CI: 92.4–100%) and 21.4% (14.6–29.6%), respectively. ConclusionsIn the setting of high vaccination coverage, we only identified SBI related to UTIs. We could not identify any OB. Our management algorithm was able to identify all SBI, but specificity was low. Refined criteria for screening of UTI could slightly increase this.

Predicting the causative pathogen among children with osteomyelitis using Bayesian networks - improving antibiotic selection in clinical practice.

Infection of bone, osteomyelitis (OM), is a serious bacterial infection in children requiring urgent antibiotic therapy. While biological specimens are often obtained and cultured to guide antibiotic selection, culture results may take several days, are often falsely negative, and may be falsely positive because of contamination by non-causative bacteria. This poses a dilemma for clinicians when choosing the most suitable antibiotic. Selecting an antibiotic which is too narrow in spectrum risks treatment failure; selecting an antibiotic which is too broad risks toxicity and promotes antibiotic resistance. We have developed a Bayesian Network (BN) model that can be used to guide individually targeted antibiotic therapy at point-of-care, by predicting the most likely causative pathogen in children with OM and the antibiotic with optimal expected utility. The BN explicitly models the complex relationship between the unobserved infecting pathogen, observed culture results, and clinical and demographic variables, and integrates data with critical expert knowledge under a causal inference framework. Development of this tool resulted from a multidisciplinary approach, involving experts in infectious diseases, modelling, paediatrics, microbiology, computer science and statistics. The model-predicted prevalence of causative pathogens among children with osteomyelitis were 56 % for Staphylococcus aureus, 17 % for 'other' culturable bacteria (like Streptococcus pyogenes), and 27 % for bacterial pathogens that are not culturable using routine methods (like Kingella kingae). Log loss cross-validation suggests that the model performance is robust, with the best fit to culture results achieved when data and expert knowledge were combined during parameterisation. AUC values of 0.68 - 0.77 were achieved for predicting culture results of different types of specimens. BN-recommended antibiotics were rated optimal or adequate by experts in 82-98% of 81 cases sampled from the cohort. We have demonstrated the potential use of BNs in improving antibiotic selection for children with OM, which we believe to be generalisable in the development of a broader range of decision support tools. With appropriate validation, such tools might be effectively deployed for real-time clinical decision support, to promote a shift in clinical practice from generic to individually-targeted antibiotic therapy, and ultimately improve the management and outcomes for a range of serious bacterial infections.

Incidence of reactive thrombocytosis in serious bacterial infections in children aged two months to twelve years and its usefulness as a predictor of serious bacterial infections

Background: The aims of the study were to estimate the incidence of reactive thrombocytosis(RT) among febrile children aged 2 months to 12 years and to identify any differences in age group and gender in mounting thrombocytosis as a response to infection, to identify if thrombocytosis occurred preferentially in any particular group of serious bacterial infections(SBI), to compare thrombocytosis with other parameters like total white cell count, C-reactive protein(CRP), cultures etc. and to assess the utility of platelet count as a potential predictor of serious bacterial infection.Methods: This was a prospective study done in Institute of Child Health and Hospital for children, Madras Medical College from September 2015 to July 2016. Inclusion criteria: Children aged 2 months to 12 years with symptoms of fever less than 6 days admitted in the paediatric wards and those seen at the outpatient department. Exclusion criteria: Children having received parenteral antibiotics.Results: Of the 500 children, 142 (28.4%) had reactive thrombocytosis. RT was mild in 120 children (24%), moderate in 16 children (3.2%), severe in 4(0.8%) and extreme in two children (0.4%). This study showed that 36.48% (85 / 233) of children under 1 year had RT (p = 0.0002).There was no significant sex related difference in mounting RT. Out of 500 children included in the study, serious bacterial infection was diagnosed among 171 children (34.2%).Pneumonia (n=100) was the most common SBI followed by urinary tract infections (n=33), meningitis (n=23), sepsis (n=15). This study showed that RT has a moderate ability to predict serious bacterial infections (AUC=0.78; PPV-75.35%).Conclusions: Incidence of reactive thrombocytosis in febrile children aged 2 months to 12 years is 28.4%. It occurs more frequently in infants and without any sex predilection. RT is associated with leucocytosis, positive CRP, positive Chest X ray findings, positive urine culture and positive CSF findings. This shows that RT has a moderate ability in predicting SBI in children.

Incidence, clinical profile, and risk factors for serious bacterial infections in children hospitalized with fever in Ujjain, India

BackgroundFever is a cause for concern for both parents and the treating pediatrician and a common reason for antibiotic overuse. However, the proportion of children hospitalized for fever with serious bacterial infection (SBI) is uncertain. We aimed to evaluate the epidemiological, clinical, hematological, and biochemical risks for SBI among the children admitted with fever.MethodThis prospective study was conducted in a rural teaching hospital in India on consecutive children, aged 3 months–12 years, presenting with fever 100 °F (37.7 °C) or higher. The presence of SBI was confirmed with one of the following criteria: (a) a positive blood culture; (b) roentgenographically confirmed pneumonia with high titres of C-reactive protein; (c) a culture-confirmed urinary tract infection; (d) enteric fever diagnosed clinically in addition to either a positive blood culture or high Widal titers; and (e) meningitis diagnosed clinically in addition to either a positive blood culture or cerebrospinal fluid culture. A predefined questionnaire was filled.ResultsA total of 302 children were included in the study, out of which 47% (95% CI 41.4–52.7%) presented with SBI. The factors associated with confirmed SBI in bivariate analysis were history of previous hospitalization, history of chronic illness, history of medication in the previous 1 week, a partially immunized child, history of common cold, moderate-grade fever, toxic look, significant lymphadenopathy, absence of BCG scar, delayed development, irritability, breathlessness, respiratory distress, poor feeding, significant weight loss, suspected urinary tract infection, hyponatremia, hypokalemia, and abnormal leucocyte count. The final generalized logistic regression model revealed partially immunized child (RR 4.26), breathlessness (RR 1.80), weight loss (RR 2.28), and suspected urinary tract infection (RR 1.95) as risk factors for the increased risk of SBI.ConclusionThe study identified multiple risk factors for SBI. Pediatricians can be made aware of these risk factors. Further studies are warranted to identify age-specific risk factors for SBI because most clinicians depend on clinical signs and symptoms to identify SBI.