[Relationship between fever degree and prognosis in children with bacterial bloodstream infection]

Area of Science:

• Pediatric critical care medicine
• Infectious disease epidemiology
• Clinical prognostication

Background:

• Bacterial bloodstream infections (BSI) are a significant cause of morbidity and mortality in children.
• Fever is a common clinical sign of infection, but its prognostic value in pediatric BSI requires further clarification.
• Understanding the relationship between initial body temperature and outcomes is crucial for timely intervention in pediatric sepsis.

Purpose of the Study:

• To investigate the association between initial body temperature recorded within 48 hours of hospital admission and mortality in pediatric patients diagnosed with bacterial bloodstream infection.
• To identify specific temperature ranges that may indicate a poorer prognosis in children with sepsis.

Main Methods:

• Retrospective analysis of clinical data from pediatric intensive care unit (PICU) patients diagnosed with sepsis between 2008 and 2016.
• Classification of children with bacterial bloodstream infection into five groups based on maximum temperature within 48 hours: <36.5°C, ≥36.5°C (control), ≥37.5°C, ≥38.5°C, and ≥39.5°C.
• Comparison of mortality rates across the defined temperature groups.

Main Results:

• A total of 213 children with bacterial bloodstream infection were analyzed, with 48 deaths.
• Mortality rates differed significantly across the temperature groups (P<0.01).
• The groups with temperatures <36.5°C and ≥39.5°C exhibited significantly higher mortality compared to the normal control group (≥36.5°C).
• No significant mortality difference was observed between the ≥37.5°C and ≥38.5°C groups and the control group.

Conclusions:

• Initial body temperature extremes (below 36.5°C or above 39.5°C) within 48 hours of admission are associated with increased mortality in children with bacterial bloodstream infection.
• These findings suggest that both hypothermia and high-grade fever at presentation are critical indicators of poor prognosis in pediatric sepsis.
• Monitoring and prompt management of these temperature extremes are essential for improving outcomes in pediatric patients with bacterial bloodstream infections.