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Invasive bacterial infections in young afebrile infants with a history of fever
Santiago Mintegi1,2, Borja Gomez1,2, Alba Carro1,2
1Pediatric Emergency Department, Cruces University Hospital, Bilbao, Spain.
Insights
Invasive bacterial infections (IBI) occur in infants under 90 days old with fever, regardless of their temperature upon arrival at the emergency department (ED). This suggests a similar diagnostic approach for febrile and afebrile infants with a history of fever.
Area of Science:
- Pediatrics
- Infectious Diseases
- Emergency Medicine
Background:
- Fever in infants under 90 days old can indicate serious invasive bacterial infections (IBI).
- The presence or absence of fever upon arrival to the emergency department (ED) may influence diagnostic and management decisions.
Purpose of the Study:
- To determine the prevalence of IBI in infants less than 90 days old with a history of fever.
- To compare IBI prevalence based on fever status upon ED arrival.
Main Methods:
- Prospective registry-based cohort study.
- Inclusion of 2470 infants (<90 days old) with a history of fever evaluated in the ED between 2003 and 2016.
- Analysis of IBI prevalence in febrile and afebrile infants on arrival.
Main Results:
- Overall IBI prevalence was 2.4% (59/2470 infants).
- IBI prevalence was similar in infants who were febrile (2.4%) and afebrile (2.4%) upon ED arrival.
- 14 out of 16 afebrile infants diagnosed with IBI appeared well.
Conclusions:
- The prevalence of IBI in infants under 90 days with a history of fever is consistent, irrespective of their temperature at ED presentation.
- Diagnostic and management strategies for infants with a history of fever should be uniform, regardless of their current febrile status.
Objective:
To determine the prevalence of invasive bacterial infections (IBI, pathogenic bacteria in blood or cerebrospinal fluid) in infants less than 90 days old with fever without a source related to the presence or absence of fever on arrival to the emergency department (ED).
Design:
Prospective registry-based cohort study.
Setting:
Paediatric ED of a tertiary teaching hospital.
Patients:
We included infants less than 90 days old with a history of fever evaluated in the ED from 2003 to 2016.
Main Outcomes And Measures:
The prevalence of IBI in patients with a history of fever who were febrile and afebrile on arrival to the ED.
Results:
We included 2470 infants: 678 afebrile and 1792 febrile when evaluated in the ED. Fifty-nine (2.4%) were diagnosed with an IBI (bacteraemia 46, meningitis 7 and sepsis 6): 16 in the group of afebrile infants with a history of fever (2.4%, 95% CI 1.4 to 3.8 vs 43 in the febrile group, 2.4%, 95% CI 1.8 to 3.2). Of the 16 afebrile infants with a history of fever diagnosed with an IBI, 14 were well appearing. The rate of non-IBI (pathogenic bacteria in urine or stools) was similar in both groups (15.5% and 16.7%).
Conclusions:
The prevalence of IBI in infants ≤90 days with a history of fever is similar regardless of the presence of fever on the arrival at the ED. The approach to infants with a history of fever who are afebrile in the ED should not differ from that recommended for infants who are febrile in the ED.
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