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[The young febrile child. Results of a multicenter survey]
Insights
Pediatrician experience combined with clinical and lab tests effectively identifies serious bacterial infections in febrile children (0-36 months). Urinary tract infections were most common, with Streptococcus pneumoniae causing most occult bacteremia.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Diagnostics
- Epidemiology
Context:
- Febrile young children (0-36 months) presenting to emergency departments require accurate diagnosis of potentially serious bacterial infections (PSBI).
- National surveys are crucial for understanding management practices and etiological patterns in specific healthcare systems.
Purpose:
- To evaluate the diagnostic value of clinical and laboratory parameters for PSBI in young febrile children in Spain.
- To determine the causative agents of PSBI in this pediatric population.
Summary:
- A prospective survey of 743 febrile children (0-36 months) identified clinical assessment as vital for detecting PSBI.
- Elevated white blood cell counts (WBC > 15,000/µL or < 5,000/µL) and C-reactive protein (CRP) were key laboratory indicators.
- Urinary tract infection (UTI) was the most frequent invasive bacterial disease, while Streptococcus pneumoniae predominated in occult bacteremia (3% incidence).
Impact:
- Findings underscore the importance of integrating clinical expertise with targeted laboratory testing for timely PSBI diagnosis in young children.
- This study contributes to evidence-based guidelines for managing febrile infants and toddlers in emergency settings.
- Understanding the etiological spectrum of PSBI aids in optimizing empirical antibiotic strategies and public health interventions.
Objectives:
To establish the value of clinical and laboratory parameters gathered from a national survey on the management of the young febrile child (0-36 months) in emergency departments and to determine the etiology of potentially serious bacterial infections in Spain in this group of patients.
Patients And Methods:
Prospective survey of febrile children aged less than 36 months who presented to the emergency departments of the participant hospitals and who fulfilled the inclusion criteria.
Results:
A total of 937 cases were collected. Of these, 43 were excluded because of absence of blood culture and 151 because the patients had not undergone obligatory monitoring until they became afebrile or had no final diagnosis. Consequently, the sample size consisted of 743 patients. Clinical assessment was very important to detect patients with potentially serious bacterial disease. Among the laboratory parameters, a white blood cell count above 15,000/l or below 5,000/l and elevated C-reactive protein levels were the most useful. Urinary tract infection was the most frequent invasive disease. Neisseria meningitidis was the most frequent microorganism isolated in the blood culture. The incidence of occult bacteremia was 3 % with predominance of Streptococcus pneumoniae (74 %).
Conclusions:
The experience of the pediatrician supported by clinical and laboratory parameters are the most effective means of detecting febrile children (0-36 months) with potentially serious bacterial disease.