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Afebrile Infants Evaluated in the Emergency Department for Serious Bacterial Infection
Aaron S Miller1, Laura E Hall, Katherine M Jones
1From the *Divisions of Hospitalist Medicine and Infectious Diseases, Department of Pediatrics, St. Louis University, St. Louis, MO; †Division of Hospitalist Medicine, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO; ‡Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN; and §Division of Infectious Diseases, Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS.
Pediatric Emergency Care
|September 29, 2015
Summary
Afebrile infants evaluated for serious bacterial infection (SBI) present with respiratory symptoms, vomiting, or seizures. Despite lower infection rates than febrile infants, they remain at risk for SBI.
Area of Science:
- Pediatrics
- Infectious Diseases
- Emergency Medicine
Background:
- Afebrile infants (0-60 days) are evaluated for serious bacterial infections (SBI).
- Clinical and laboratory findings in afebrile infants undergoing SBI evaluation are not well-described.
- Comparison to febrile infants is needed to understand risk stratification.
Purpose of the Study:
- To describe clinical and laboratory findings in afebrile infants evaluated for SBI.
- To compare these findings to febrile infants undergoing similar evaluations.
Main Methods:
- Retrospective observational study.
- Inclusion criteria: infants 0-60 days admitted with at least 2 of 3 bacterial cultures (blood, urine, CSF).
- Comparison between afebrile and febrile infant groups.
Main Results:
- 579 infants met criteria (362 febrile, 217 afebrile).
- Common chief complaints in afebrile infants: respiratory symptoms (27%), seizure (22%), vomiting/diarrhea (21%).
- No statistically significant difference in positive blood or urine cultures between afebrile and febrile groups; meningitis only in febrile group.
Conclusions:
- Afebrile infants constitute a significant portion of SBI evaluations.
- Respiratory symptoms, vomiting, and seizures are common presentations in afebrile infants.
- Afebrile infants are at risk for SBI, necessitating careful evaluation despite lower infection rates.
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