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Changing epidemiology of serious bacterial infections in febrile infants without localizing signs

Kevin Watt1, Erica Waddle, Ravi Jhaveri

  • 1Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, United States of America.

Plos One
|September 1, 2010
PubMed
Abstract

Insights

Serious bacterial infections (SBIs) in infants with fever without localizing signs (FWLS) have increased, primarily due to E. coli urinary tract infections (UTIs). This highlights the need for urine testing and consideration of antibiotic resistance in febrile infants.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Epidemiology

Background:

  • Fever without localizing signs (FWLS) in infants presents diagnostic challenges.
  • Historical management strategies for FWLS have evolved with changing infection patterns.
  • Recent advances in medical practice may have impacted the epidemiology of serious bacterial infections (SBIs) in infants.

Purpose of the Study:

  • To investigate the temporal trends in the rate of SBIs among infants presenting with FWLS.
  • To test the hypothesis that the incidence of SBIs in this population has changed over time.
  • To analyze changes in ampicillin resistance rates associated with SBIs.

Main Methods:

  • Retrospective review of infant cases meeting FWLS criteria from 1997-2006.
  • Examination of clinical and outcome data for all identified infants.
  • Statistical analysis of SBI rates and antibiotic resistance patterns.

Main Results:

  • A total of 668 infants met FWLS criteria.
  • The overall SBI rate was 10.8%, with a significant increase observed from 2002-2006 (14.4%) compared to 1997-2001 (6.5%).
  • The rise in SBIs was predominantly driven by an increase in E. coli urinary tract infections (UTIs), particularly in infants aged 31-90 days.

Conclusions:

  • A significant increase in E. coli UTIs was observed in FWLS infants, accompanied by high ampicillin resistance rates.
  • The findings underscore the importance of urine testing in all febrile infants younger than 90 days.
  • Empirical antibiotic selection for febrile infants should consider local resistance patterns.

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