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Risk factors for urinary tract infections in children aged 0-36months presenting with fever without source and
J A Williams-Smith1, Y Fougère2, J-Y Pauchard1
1Service of Pediatrics, Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, 1000 Lausanne, Switzerland.
Insights
In vaccinated children with fever without source, urinary tract infections were the only serious bacterial infections found. A management algorithm identified all infections but had low specificity.
Area of Science:
- Pediatric infectious diseases
- Epidemiology of childhood infections
- Clinical management algorithms
Background:
- Children under 36 months with fever without source (FWS) are at risk for serious bacterial infections (SBI).
- The incidence of occult bacteremia (OB) has significantly decreased in vaccinated children.
- Evaluating the epidemiology and management of SBI in this population is crucial.
Purpose of the Study:
- To describe the epidemiology of SBI in children presenting with FWS.
- To assess the performance of a clinical management algorithm for identifying SBI in this cohort.
- To identify predictors of SBI in young children with FWS.
Main Methods:
- Prospective cohort study design.
- Inclusion of children aged 0-36 months with FWS in an emergency unit.
- Systematic recording of demographic, clinical, and investigational data, followed by 10-day outcome assessment.
Main Results:
- 173 children were recruited; 96% were up-to-date with vaccinations.
- Serious bacterial infections (SBI) were diagnosed in 27% of children, exclusively as urinary tract infections (UTI).
- Predictors for UTI included chills, fever duration >2 days, and age <9 months. The management algorithm demonstrated 100% sensitivity but 21.4% specificity for SBI.
Conclusions:
- In a highly vaccinated cohort, UTIs were the sole identified SBI among children with FWS; no cases of OB were detected.
- The current management algorithm effectively identifies all SBIs but requires improvement in specificity.
- Refining screening criteria for UTI may enhance the algorithm's specificity.
Background:
Children younger than 36 months with fever without a source (FWS) are at risk of serious bacterial infections (SBI). The risk of occult bacteremia (OB) has been greatly reduced in vaccinated children. The aim of this study is to describe the epidemiology of SBI in children with FWS in our setting and to evaluate the performance of our management algorithm.
Methods:
We designed a prospective cohort study. We included children aged 0-36 months presenting with FWS in our emergency unit. Demographic and clinical characteristics, investigations, and management procedures were recorded at the time of inclusion. Information on clinical evolution, final diagnosis, and immunization history were obtained after 10 days. Potential predictors of SBI were compared between patients with and without SBI.
Results:
Between October 2015 and September 2017, 173 children were recruited, with a median age of 4.4 months (2.1-1). Of these children, 166 (96%) were up to date with their vaccinations. A total of 47 children (27%) had a final diagnosis of SBI, which were all urinary tract infections (UTI). Presence of chills (odds ratio [OR] 5.6, 95% confidence interval [CI] 1.3-24.3), fever for>2 days (OR 29.1, 95% CI 3.5-243.5), and age<9 months (OR: 45.3, 95% CI: 4.9-415.7) were statistically significant predictors of UTI in a multivariate logistic regression. The sensitivity and specificity of our management algorithm were 100% (95% CI: 92.4-100%) and 21.4% (14.6-29.6%), respectively.
Conclusions:
In the setting of high vaccination coverage, we only identified SBI related to UTIs. We could not identify any OB. Our management algorithm was able to identify all SBI, but specificity was low. Refined criteria for screening of UTI could slightly increase this.
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