Related Experiment Video
Updated: Oct 12, 2025
A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Trends in ED Resource Use for Infants 0 to 60 Days Evaluated for Serious Bacterial Infection
Christina S Hernandez1, Michael C Monuteaux2, Richard G Bachur2
1Division of Emergency and Transport Medicine, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California.
Insights
Resource use for serious bacterial infections in infants decreased, particularly in older infants. Procalcitonin testing increased but showed no association with lumbar puncture, antibiotics, or hospitalization rates.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Health Services Research
Background:
- Serious bacterial infections (SBIs) in infants necessitate careful resource utilization in emergency departments.
- Trends in diagnostic and treatment pathways for SBI in infants have evolved.
- Procalcitonin testing has emerged as a biomarker to guide antibiotic use.
Purpose of the Study:
- To examine trends in resource use for infants evaluated for SBI.
- To assess the association between procalcitonin testing and key clinical decisions like lumbar puncture, antibiotic administration, and hospitalization.
- To compare trends between younger (0-28 days) and older (29-60 days) infants.
Main Methods:
- Cross-sectional study of 106,547 infant visits (0-60 days) across 27 hospitals from 2010-2019.
- Analysis of temporal trends in lumbar puncture (LP), antibiotic administration, hospitalization, and procalcitonin testing.
- Multivariable logistic regression models (2017-2019) to assess the association between hospital-level procalcitonin use and resource utilization outcomes.
Main Results:
- Significant decreases in LP, antibiotic administration, and hospitalization rates were observed from 2010-2019, with steeper declines in infants aged 29-60 days.
- Procalcitonin testing increased significantly annually, with the majority conducted in 2017-2019.
- No association was found between hospital-level procalcitonin testing and rates of LP, antibiotic administration, or hospitalization from 2017-2019.
Conclusions:
- Resource utilization for SBI evaluation in infants, including LP, antibiotics, and hospitalization, has decreased, particularly in infants aged 29-60 days.
- Despite a rise in procalcitonin testing, it did not correlate with changes in resource use patterns during the study period.
- Further research may be needed to understand the impact of procalcitonin on clinical decision-making in this population.
Objectives:
We examined trends in resource use for infants undergoing emergency department evaluation for serious bacterial infection, including lumbar puncture (LP), antibiotic administration, hospitalization, and procalcitonin testing, as well as the association between procalcitonin testing and LP, administration of parenteral antibiotics, and hospitalization.
Methods:
We performed a cross-sectional study of infants aged 0 to 60 days who underwent emergency department evaluation for serious bacterial infection with blood and urine cultures from 2010 to 2019 in 27 hospitals in the Pediatric Health Information System. We examined temporal trends in LP, antibiotic administration, hospitalization, and procalcitonin testing from 2010 to 2019. We also estimated multivariable logistic regression models for 2017-2019, adjusted for demographic factors and stratified by age (<28 and 29-60 days), with LP, antibiotic administration, and hospitalization as dependent variables and hospital-level procalcitonin testing as the independent variable.
Results:
We studied 106 547 index visits. From 2010 to 2019, rates of LP, antibiotic administration, and hospitalization decreased more for infants aged 29 to 60 days compared with infants aged 0 to 28 days (annual decrease in odds of LP, antibiotics administration, and hospitalization: 0 to 28 days: 5%, 5%, and 3%, respectively; 29-60 days: 15%, 12%, and 7%, respectively). Procalcitonin testing increased significantly each calendar year (odds ratio per calendar year 2.19; 95% confidence interval 1.82-2.62), with the majority (91.1%) performed during 2017-2019. From 2017 to 2019, there was no association between hospital-level procalcitonin testing and any outcome studied (all P values > .05).
Conclusions:
Rates of LP, antibiotic administration, and hospitalization decreased significantly for infants 29 to 60 days during 2010-2019. Although procalcitonin testing increased during 2017-2019, we found no association with hospital-level procalcitonin testing and patterns of resource use.
More Related Videos
Related Concept Videos
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...