Invasive Bacterial Infections in Afebrile Infants Diagnosed With Acute Otitis Media

Area of Science:

• Pediatrics
• Infectious Diseases
• Emergency Medicine

Background:

• Acute otitis media (AOM) is a common childhood illness, but invasive bacterial infections (IBIs) and adverse events are serious concerns in infants.
• Afebrile infants with AOM present a diagnostic challenge, as the absence of fever may not rule out serious underlying infections.

Purpose of the Study:

• To determine the prevalence of invasive bacterial infections (IBIs) and adverse events in afebrile infants diagnosed with acute otitis media (AOM).
• To evaluate the necessity of diagnostic testing for IBIs in this specific patient population.

Main Methods:

• A cross-sectional study involving 1637 afebrile infants aged ≤90 days with AOM across 33 sites.
• Invasive bacterial infections (bacteremia and meningitis) were identified via blood or cerebrospinal fluid (CSF) cultures.
• Adverse events were defined as substantial complications potentially associated with AOM, with 30-day follow-up.

Main Results:

• No cases of bacteremia (0%) or bacterial meningitis (0%) were detected in the studied infants.
• A low incidence of adverse events (0.3%) was observed, including lymphadenitis and culture-negative sepsis.
• Diagnostic testing for IBIs varied significantly by age and site, with older infants less likely to undergo blood or CSF cultures.

Conclusions:

• Afebrile infants diagnosed with AOM exhibit a low prevalence of invasive bacterial infections and adverse events.
• Outpatient management without routine diagnostic testing for IBIs appears to be a reasonable and safe approach for these infants.