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Invasive Bacterial Infections in Afebrile Infants Diagnosed With Acute Otitis Media

Son H McLaren1, Andrea T Cruz2, Kenneth Yen3

  • 1Department of Emergency Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; shm2108@cumc.columbia.edu.

Pediatrics
|December 8, 2020
PubMed

Insights

Afebrile infants with acute otitis media (AOM) have a very low risk of invasive bacterial infections (IBIs) and adverse events. Outpatient management without diagnostic testing may be a safe and reasonable approach for these young patients.

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.
Abstract

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