Serious Bacterial Infection In Infants Research Articles

Delayed presentation is associated with serious bacterial infections among febrile infants: A prospective cohort study.

Febrile young infants are at risk of serious bacterial infections (SBIs), which are potentially life-threatening. This study aims to investigate the association between delayed presentation and the risk of SBIs among febrile infants. We performed a prospective cohort study on febrile infants ≤90 days old presenting to a Singapore paediatric emergency department (ED) between November 2017 and July 2022. We defined delayed presentation as presentation to the ED >24 hours from fever onset. We compared the proportion of SBIs in infants who had delayed presentation compared to those without, and their clinical outcomes. We also performed a multivariable logistic regression to study if delayed presentation was independently associated with the presence of SBIs. Among 1911 febrile infants analysed, 198 infants (10%) had delayed presentation. Febrile infants with delayed presentation were more likely to have SBIs (28.8% versus [vs] 16.3%, P<0.001). A higher proportion of infants with delayed presentation required intravenous antibiotics (64.1% vs 51.9%, P=0.001). After adjusting for age, sex and severity index score, delayed presentation was independently associated with the presence of SBI (adjusted odds ratio [AOR] 1.78, 95% confidence interval 1.26-2.52, P<0.001). Febrile infants with delayed presentation are at higher risk of SBI. Frontline clinicians should take this into account when assessing febrile infants.

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.

Utility of the systemic immune-inflammation index to predict serious bacterial infections in infants with fever without a source

ABSTRACT Introduction This study analyzed the utility of the systemic immune-inflammation index (SII) in predicting serious bacterial infections (SBIs) in infants with fever without a source (FWS). Methods Infants (aged 1–4 months) evaluated in the pediatric emergency department for FWS were divided into two groups: with SBI and without SBI. The efficacy of inflammatory markers in predicting SBI was compared. Results The study included 223 infants with a mean age of 76.65 ± 25.42 days; 62 (27.8%) of them were included in the SBI group, and all of them were diagnosed with a urinary tract infection (UTI). The hospitalization rate and length of hospital stay were significantly higher in UTI patients (p < 0.001 for each). The mean SII was 795.76 ± 475.85 in the SBI group and 318.24 ± 300.70 in the non-SBI group, and there was a significant difference between the groups (p < 0.001). In diagnosis of SBI, the area under the curve values were found to be 0.89 [95% confidence interval (CI): 0.85–0.94] for C-reactive protein (CRP), 0.86 (95% CI: 0.81–0.91) for absolute neutrophil count (ANC), 0.84 (95% CI: 0.78–0.89) for the SII, and 0.81 (95% CI: 0.74–0.87) for WBC. In the multivariate logistic regression analysis, high CRP and SII values were found to be predictive factors for UTI without bacteremia (p < 0.001 and p = 0.008, respectively). Conclusion We found that high CRP and SII values could be predictive for UTI without bacteremia in infants with FWS. The SII may be preferred because it can be easily calculated using the hemogram results, is not accompanied by extra costs, and does not require further blood collection.

43 The Prevalence of Serious Bacterial Infections in Infants less than 90 Days with and without Features of a Viral Infection: A Retrospective Cohort Study

Abstract Primary Subject area Emergency Medicine - Paediatric Background Prior studies suggest the prevalence of serious bacterial infections (SBI) (i.e., urinary tract infection [UTI], bacteremia, or meningitis) is lower in infants with a viral infection compared to those with fever without a source (FWS) (2-3% vs. 10-15%). Objectives To determine the difference in proportion of SBI in infants with and without clinical features of a viral infection. Design/Methods A retrospective cohort study was done on a consecutive sample of infants ≤ 90 days seen at a pediatric ED over a 5-year period ending August 30, 2019. Eligible subjects had rectal temperatures ≥ 38°C, and had ≥ 1 screening test for SBI (urine, blood and/or cerebrospinal fluid cultures). Excluded were infants who received antibiotics in the past 7 days, had congenital anomalies, required intensive care, or were preterm. We defined a clinical viral infection as &amp;gt; 1 clinical features of a respiratory viral infection (new-onset sneezing, cough, rhinorrhea, or shortness of breath). UTI was defined as per American Academy of Pediatrics guidelines. Results We screened 7021 charts and 885 (12%) were eligible. Of these, 498 (56%) had a clinical viral infection and 387 (44%) did not. Blood and urine cultures were collected from 860 (97%) infants and 308 (35%) had a lumbar puncture. Overall, 84 (10%) infants had an SBI: 76 (9%) UTI, 6 (0.7%) isolated bacteremia, and 2 (0.2%) meningitis. Among those with clinical viral infection, 23 (5%) had SBI, compared to 61 (16%) without viral infection (risk difference [RD] 11%, 95% CI [7%, 15%]). Both cases of meningitis occurred in infants ≤28 days and without any viral symptoms. A logistic regression was done to ascertain the effects of clinical viral infection, known risk factors for sepsis, age ≤ 28 days, or a temperature ≥ 39°C on the likelihood of SBI. Of the 4 predictors, only clinical viral infection and the presence of known risk factors for sepsis were significantly associated with SBI (odds ratio [OR] 0.3, 95% CI [0.17, 0.48] and 2.5, 95% CI [1.4, 4.5], respectively). Proportions of contaminated blood culture and urine culture were 5% (95% CI [4%, 7%]) and 14% (95% CI [12%, 17%]), respectively. Conclusion SBI prevalence in infants without features of a viral infection on assessment is triple that of infants with viral symptoms. Contaminant blood and urine cultures are folds higher than true pathological cultures. Future research is needed to identify infants at low risk of SBI without invasive testing.

88 Risk of Serious Bacterial Infections among Recently Immunized Young Febrile Infants in the General Emergency Setting

Fever following routine immunizations is a common presenting complaint for young infants in the emergency department (ED). Controversy remains over which well-appearing young febrile infants are at high risk for serious bacterial infection (SBI). The objective of this study was to determine the prevalence of SBI in febrile young infants 6-12 weeks who received immunizations in the preceding 72 hours. The authors conducted a retrospective chart review of infants 6-12 weeks who presented with a fever ≥ 38°C to two military academic emergency departments (ED) over a 4-year period. This study was part of a larger review of febrile infants (between the ages of 0-160 days) investigating rates of SBI and resource utilization pre-and post-implementation of standardized febrile infant clinical pathways. Infants were considered recently immunized (RI) if they had received immunizations within the 72 hours prior to presenting to the ED and not recently immunized (NRI) if they had not received immunizations during this time period. The primary outcome of SBI was based on culture results and final radiology interpretation of chest radiographs. 508 febrile infants were reviewed, of whom 114 had received immunizations (RI) in the prior 72 hours. The overall prevalence of SBI was 11.4% (95% CI = 8.9-14.6) in our study population. The prevalence of SBI in infants not recently immunized (NRI) was 13.7% (95% CI = 10.6-17.6) compared to 3.5% (95% CI = 1.1-9.3) in the infants recently immunized (RI) (see Table 1). The prevalence of SBI in febrile infants who received immunizations within the prior 24 hours was 2% (95% CI = 0.4-7.9) compared to 14.3% (95% CI = 2.5-43.9) in those recently immunized infants who received immunizations greater than 24 hours prior to presentation (see Table 2). The relative risk of SBI in the setting of recent immunizations was 0.3 (95% CI = 0.1-0.7). All but one SBI in the RI group were urinary tract infections (UTI). The single non-UTI was a case of pneumonia in an infant who presented with respiratory symptoms within 24 hours of immunizations. There were no cases of bacteremia or meningitis identified. The prevalence of SBI in febrile young infants presenting within the first 24 hours following immunizations is less compared to those not recently immunized. UTI, however, remains a substantial risk in this population and should be investigated as a potential source of fever. Future research utilizing a large prospective multi-center data registry would aid in further defining the risk of SBI among recently immunized infants.Table 1SBI in Infants with RI and NRIAll (n=508) n % (95% CI)RI (n=114) n (%, 95% CI)NRI (n=394) n (%, 95% CI)Bacteremia3 (0.6%, 0.2-1.9)0 (0%, 0-4)3 (0.8%, 0.2-2.4)UTI47 (9.3%, 6.9-12.2)3 (2.6%, 0.7-8)44 (11.2%, 8.3-14.8)Meningitis1 (0.2%, 0.01-1.3)0 (0%, 0-4)1 (0.3%, 0.1-1.6)Pneumonia6 (1.2%, 0.5-2.7)1 (0.9%, 0.05-5.5)5 (1.3%, 0.5-3.1)Other SBI1 (0.2%, 0.01-1.3)∗0 (0%, 0-4)1 (0.3%, 0.1-1.6)∗Overall SBI58 (11.4%, 8.9-14.6)4 (3.5%, 1.1-9.3)54 (13.7%, 10.6-17.6)∗One infant with salmonella enteritis Open table in a new tab Table 2SBI in Infants with RI Compared to Infants with NRIPrevalence of SBI (95% CI)Relative Risk (95% CI)NRI (n=394)54 (13.7%, 10.6-17.6)Reference groupRI (overall) (n=114)4 (3.5%, 1.1-9.3)0.3 (0.1-0.7)RI <24 hours (n=98)2 (2%, 0.4-7.9)0.2 (0.04-0.6)RI 24-48 (n=14)2 (14.3%, 2.5-43.9)1.04 (0.3-3.9) Open table in a new tab

Accuracy of PECARN rule for predicting serious bacterial infection in infants with fever without a source

ObjectiveTo validate the Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN) clinical prediction rule on an independent cohort of infants with fever without a source...

Presentation, Diagnostic Evaluation, Management, and Rates of Serious Bacterial Infection in Infants With Acute Dacryocystitis Presenting to the Emergency Department.

Dacryocystitis is considered benign, yet infants represent a population at risk of complications. The presentation, management, and rates of serious bacterial infection in infants with dacryocystitis have not been described. We conducted a retrospective study of infants (12 months or younger) presenting to a single urban tertiary care pediatric emergency department between January 1995 and March 2014 with concern for dacryocystitis. Exclusion criteria included immune compromise or craniofacial anomalies. Cases were identified using text search software, followed by manual chart review. We identified 333 subjects, and median age was 38 days (interquartile range, 12; 106). Fifty-three percent were female. Most were afebrile (81%, T < 38°C) at triage while 6% had fever of ≥39°C. Two of 135 blood cultures sent were positive (both Streptococcus pneumoniae). Lumbar punctures were performed on 40 patients (12%), and no cerebrospinal fluid (CSF) cultures were positive. Eye cultures were positive in 47% (N = 58) of infants cultured (N = 123); the most common pathogens were Haemophilus species (N = 17), Staphylococcus aureus (N = 13), Gram-negative rods (N = 7), and Moraxella species (N = 4). Imaging was obtained in 11 subjects (3.3%) with 3 demonstrating cellulitis and 1 a hemangioma. Ophthalmology was consulted for 21%, and an intervention/probe performed in 6%. Topical antibiotics were used in 147 subjects (44%), oral antibiotics in 100 (33%), and parenteral antibiotics in 87 (26%). Infants with dacryocystitis have a variable presentation and management ranges from observation to aggressive management. The rates of serious bacterial infection were low in this sample and not associated with any presenting risk factors.

Prevalence of Bacterial Infection in Febrile Infant 61–90 Days Old Compared With Younger Infants

The objective is to compare the prevalence of serious bacterial infection (SBI) and invasive bacterial infection (IBI) in febrile infants <60 days of age and in those between 61 and 90 days. Prospective registry-based cohort study including all the infants ≤90 days with fever without a source evaluated in a pediatric emergency department between 2003 and 2017. We compared the prevalence of SBI and IBI in febrile infants <60 days of age and those between 61 and 90 days. We included 3,301 infants. Overall, 605 (18.3%) had a SBI (mainly urinary tract infection), of these 81 (2.5%) had an IBI (bacteremia 60, meningitis 12, sepsis 9). The prevalence of SBI in infants >60 days old was 18.5% (95% CI: 16.4-20.7) versus 16.6% (95% CI: 14.7-18.7; n.s.) in those between 29 and 60 days and versus 21.5% (95% CI: 18.6-24.7; n.s.) in those <28 days of age. The prevalence of IBI among infants >60 days old was 1.1% (95% CI: 0.6-2.2) versus 2.3% (95% CI: 1.6-3.3; P < 0.05) in those between 29 and 60 days and 5.1% (95% CI: 3.7-7.0; P < 0.05) in those <28 days of age. The prevalence of IBI in well appearing >60 days was 1.0% (versus 4.5% in those <28 days old, P < 0.01; and 2.0% in those between 29 and 60 days, P = 0.06). All bacterial meningitis, except one, were diagnosed in infants <28 days. The prevalence of IBI in febrile infants between 61 and 90 days of age is high enough to support the recommendation for obtaining urine and blood tests in this population.

Risk of serious bacterial infections in infants ≤60 days of age presenting to the emergency department with a history of fever only

Risk of serious bacterial infections in infants ≤60 days of age presenting to the emergency department with a history of fever only

Factors associated with serious bacterial infections in infants ≤60 days with hypothermia in the emergency department

BackgroundWe sought to investigate risk factors for serious bacterial infection (SBI: bacterial meningitis, bacteremia, and urinary tract infection [UTI]) among infants ≤60 days of age presenting to the emergency department (ED) with hypothermia (temperature < 36 °C). MethodsWe performed a single center study over a 12-year period including all patients ≤60 days old with hypothermia, excluding patients who did not receive a blood culture and patients who received antibiotics prior to culture acquisition. The primary outcome was SBI. Secondary outcomes were mortality and herpes simplex infection. We performed multivariable logistic regression to identify risk factors for primary outcomes reporting adjusted odds ratios with 95% confidence intervals (aOR, 95% CI). Results360 infants were identified. 10/360 (2.8%) had an SBI. All episodes of SBI occurred in infants ≤28 days of age. Two patients had meningitis, two had meningitis with bacteremia, one had isolated bacteremia, and five had UTI. Associated diagnoses included prematurity (46.9%), hyperbilirubinemia (28.3%) and dehydration (14.7%). In multivariable analysis, presentation at 15–28 days (7.60, 1.81–31.86; p = 0.005) compared to 0–14 days, higher absolute neutrophil count (1.25, 1.04–1.50; p = 0.015) and lower platelet count (0.99, 0.99–1.00; p = 0.046) were associated with SBI. Three patients without SBI died during or soon after their hospitalization. One patient had positive testing for herpes simplex. ConclusionIn this cohort of hypothermic infants, 2.8% had a SBI. Age of presentation, ANC, and lower platelet count were associated with serious infections. Hypothermic infants presenting to the ED carry significant morbidity and require prospective study to better risk-stratify this population.

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.

Renal scarring in children under 36 months hospitalised for acute pyelonephritis

Abstract Introduction Acute pyelonephritis (APN) is one of the most common causes of serious bacterial infection in infants. Renal scarring is the most prevalent long-term complication. Objectives To review the incidence of renal scarring within 6 months after an episode of APN in children under 36 months and its relationship with imaging studies, clinical settings, and bacteriology. Method A retrospective study of previously healthy patients aged one to 36 months, admitted for a first episode of APN, with a minimum follow-up of 6 months. Demographic and clinical variables were collected along with bacteriology, renal and bladder ultrasound scan, voiding cystourethrography, DMSA-scintigraphy, and re-infection events. Results A total of 125 patients were included in the study, of which 60% were male, the large majority (92%) febrile, and due to Escherichia coli (74.6%). There was a history of prenatal ultrasound scan changes in 15.4%. Ultrasound scan found dilation of the urinary tract in 22.1%. Voiding cystourethrography was performed on 70 patients: 54.3% no abnormalities, 12.8% vesicoureteral reflux (VUR) grade i - iii , and 32.9% iv - v grade VUR. Six patients had iv - v grade VUR with a normal ultrasound scan. Adherence to DMSA-scintigraphy at 6 months was only 61% of that indicated. Renal scarring was found in 44.3% of those in which it was performed (60 cases). Conclusions Almost half (44%) DMSA-scintigraphy in children aged one to 36 months hospitalised for APN show renal scarring at 6 months, which was found to be associated with the re-infection events and the iv - v grade VUR. There was no relationship between scarring and the bacteriology or the elevations of inflammatory biochemical markers.

New prediction model for diagnosis of bacterial infection in febrile infants younger than 90 days.

Vujevic M, Benzon B, Markic J. New prediction model for diagnosis of bacterial infection in febrile infants younger than 90 days. Turk J Pediatr 2017; 59: 261-268. Due to non-specific clinical presentation in febrile infants, extensive laboratory testing is often carried out to distinguish simple viral disease from serious bacterial infection (SBI). Objective of this study was to compare efficacy of different biomarkers in early diagnosis of SBI in infants < 90 days old. Also, we developed prediction models with whom it will be possible to diagnose SBI with more accuracy than with any biomarkers independently. Febrile < 90-day-old infants hospitalized in 2-year-period at Department of Pediatrics, University Hospital Centre Split with suspicion of having SBI were included in this study. Retrospective cohort analysis of data acquired from medical records was performed. Out of 181 enrolled patients, SBI was confirmed in 70. Most common diagnosis was urinary tract infection (68.6%), followed by pneumonia (12.9%), sepsis (11.4%), gastroenterocolitis (5.7%) and meningitis (1.4%). Male gender was shown to be a risk factor for SBI in this population (p=0.008). White blood cell count (WBC), absolute neutrophil count (ANC) and C-reactive protein (CRP) were confirmed as the independent predictors of SBI, with CRP as the best one. Two prediction models built by combining biomarkers and clinical variables were selected as optimal with sensitivities of 74.3% and 75.7%, and specificities of 88.3% and 86%. Evidently, CRP is a more superior biomarker in diagnostics of SBI comparing to WBC and ANC. Prediction models were shown to be better in predicting SBI than independent biomarkers. Although both showed high sensitivity and specificity, their true strength should be determined using validation cohort.

Risk of Serious Bacterial Infection in Infants With an Identified Virus on Rapid Viral Diagnostics

Risk of Serious Bacterial Infection in Infants With an Identified Virus on Rapid Viral Diagnostics

Cicatrices renales en menores de 36 meses ingresados por pielonefritis aguda

IntroductionAcute pyelonephritis (APN) is one of the most common causes of serious bacterial infection in infants. Renal scarring is the most prevalent long-term complication. ObjectivesTo review the incidence of renal scarring within 6 months after an episode of APN in children under 36 months and its relationship with imaging studies, clinical settings, and bacteriology. MethodA retrospective study of previously healthy patients aged one to 36 months, admitted for a first episode of APN, with a minimum follow-up of 6 months. Demographic and clinical variables were collected along with bacteriology, renal and bladder ultrasound scan, voiding cystourethrography, DMSA-scintigraphy, and re-infection events. ResultsA total of 125 patients were included in the study, of which 60% were male, the large majority (92%) febrile, and due to E. coli (74.6%). There was a history of prenatal ultrasound scan changes in 15.4%. Ultrasound scan found dilation of the urinary tract in 22.1%. Voiding cystourethrography was performed on 70 patients: 54.3% no abnormalities, 12.8% vesicoureteral reflux (VUR) grade i-iii, and 32.9% iv-v grade VUR. Six patients had iv-v grade VUR with a normal ultrasound scan. Adherence to DMSA-scintigraphy at 6 months was only 61% of that indicated. Renal scarring was found in 44.3% of those in which it was performed (60 cases). ConclusionsAlmost half (44%) DMSA-scintigraphy in children aged one to 36 months hospitalised for APN show renal scarring at 6 months, which was found to be associated with the re-infection events and the iv-v grade VUR. There was no relationship between scarring and the bacteriology or the elevations of inflammatory biochemical markers.

A Meta-analysis of the Rates of Listeria monocytogenes and Enterococcus in Febrile Infants.

A change in the epidemiology of pathogens causing serious bacterial infection (SBI) has been noted since original recommendations were made for the empirical antibiotic choices for young infants with fever. To assess the prevalence of SBI caused by Listeria monocytogenes and Enterococcus species. A literature search was conducted on keywords related to SBI, L. monocytogenes, and Enterococcus spp. infections. Eligible studies were those conducted in the United States and published between January 1998 and June 2014 focusing on SBI in infants≤90 days of age. The rates of urinary tract infection, bacteremia, and meningitis for each pathogen were recorded for each study. Meta-analysis was performed to calculate the prevalence for each pathogen in a random effects model with 0.5 continuity correction added to studies with zero events. Sixteen studies were included. A total of 20,703 blood cultures were included, with weighted prevalences for L. monocytogenes and Enterococcus spp. bacteremia of 0.03% and 0.09%, respectively. A total of 13,775 cerebrospinal fluid cultures were included with event rates (unweighted prevalences) for L. monocytogenes and Enterococcus spp. meningitis of 0.02% and 0.03%, respectively. A total of 18,283 urine cultures were included, with no cases of L. monocytogenes and a weighted prevalence for Enterococcus spp. urinary tract infection of 0.28%. There may have been reporting bias or incomplete retrieval or inadvertent exclusion of relevant studies. SBI caused by L. monocytogenes and Enterococcus spp. in febrile infants is rare, and therefore clinicians may consider a change in empirical antibiotic choices.

Antibiotic Duration for Bacteremic Urinary Tract Infections in Infants

Urinary tract infection (UTI) is the most common serious bacterial infection in infants, and the risk of concomitant bacteremia is highest in very

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.

Does extreme leukocytosis predict serious bacterial infections in infants in the post-pneumococcal vaccine era? The experience of a large, tertiary care pediatric hospital.

Extreme leukocytosis, defined as a peripheral white blood cell count greater than 25,000/mm, may alarm clinicians and prompt extensive evaluation in infants with fever, especially in the pediatric emergency department. We reviewed data from children aged 3 to 36 months with extreme leukocytosis, fever and the risk of serious bacterial infections (SBI) at our institution from July 2010 to December 2012, a period after the universal introduction of pneumococcal vaccine. Serious bacterial infection was recorded in 57 (39%) of the 147 infants. The most common SBI were segmental or lobar pneumonia, in 28 (19%) patients, and urinary tract infection in 16 (10.9%) patients. Three patients had positive blood cultures, corresponding to a bacteremia rate of 2%. C-reactive protein was significantly higher in the SBI group than in the non-SBI group. All well-looking febrile infants with white blood cell greater than 25,000/mm should undergo a chest radiograph unless there are clear physical findings that indicate a different etiology. Urine culture should be considered in women. C-reactive protein can have an added value in the differential diagnosis.