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Factors Associated with Adverse Outcomes among Febrile Young Infants with Invasive Bacterial Infections

Christopher M Pruitt1, Mark I Neuman2, Samir S Shah3

  • 1Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.

The Journal of Pediatrics
|October 10, 2018
PubMed

Insights

Prematurity, ill appearance, and bacterial meningitis significantly increase adverse outcomes in febrile infants with invasive bacterial infections (IBI). These factors are crucial for guiding clinical decisions in young infants with IBI.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Neonatology

Background:

  • Febrile young infants (≤60 days) with invasive bacterial infections (IBI) face potential adverse outcomes.
  • Identifying risk factors is crucial for timely and appropriate clinical management.

Purpose of the Study:

  • To determine clinical factors associated with 30-day adverse outcomes in febrile infants with IBI.
  • To inform clinical decision-making for this vulnerable population.

Main Methods:

  • Retrospective cohort study of febrile infants ≤60 days with pathogenic bacteria in blood or cerebrospinal fluid (July 2011-June 2016).
  • Data extracted via medical record review; mixed-effect logistic regression used to identify factors associated with adverse outcomes (death, neurologic sequelae, mechanical ventilation, vasoactive medication).

Main Results:

  • 350 infants included; 71 (20.3%) had bacterial meningitis, 279 (79.7%) had bacteremia without meningitis.
  • 12.0% experienced 30-day adverse outcomes, with significantly higher rates in bacterial meningitis (40.8%) vs. bacteremia (4.7%).
  • Bacterial meningitis (aOR 16.3), prematurity (aOR 7.1), and ill appearance (aOR 3.8) were independently associated with adverse outcomes.

Conclusions:

  • Prematurity, ill appearance, and bacterial meningitis are key predictors of adverse outcomes in febrile infants with IBI.
  • These findings can guide risk stratification and clinical management strategies.
  • Infants without these risk factors had very low adverse event rates (1.1%).
Abstract

Keywords:
bacteremiabacterial meningitisprematurity

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