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Low adherence to a new guideline for managing febrile infants ≤59 days

Matilda Elliver1, Josefin Norrman1, Ioannis Orfanos1,2

  • 1Department of Clinical Sciences, Lund University, Lund, Sweden.

Frontiers in Pediatrics
|June 19, 2024
PubMed

Insights

A new guideline for febrile infants increased investigations and antibiotic use but did not improve serious bacterial infection diagnosis. Low adherence may be justified, suggesting a need for strategies to minimize interventions in infants with fever without source.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Clinical Guidelines

Background:

  • Management of young febrile infants presents challenges.
  • Existing guidelines aim to standardize care for febrile infants.
  • Limited data exists on the real-world impact of novel management guidelines.

Purpose of the Study:

  • To assess the impact of a new guideline on managing febrile infants aged ≤59 days.
  • To evaluate adherence to the novel guideline in clinical practice.
  • To determine if the guideline improved the diagnosis of serious bacterial infections (SBIs).

Main Methods:

  • Retrospective cross-sectional study in two Swedish pediatric emergency departments (2014-2021).
  • Comparison of infant management before and after guideline implementation.
  • Analysis focused on infants aged ≤59 days with fever without source (FWS).

Main Results:

  • Urine cultures, blood cultures, lumbar punctures, and antibiotic use increased significantly in infants ≤21 days post-guideline.
  • Adherence to recommended management was low (28%) in infants ≤21 days.
  • Prevalence of SBIs and delayed urinary tract infection treatment remained unchanged.

Conclusions:

  • Increased investigations and antibiotic use did not enhance SBI diagnosis.
  • Low adherence to the guideline suggests current practices may be justifiable.
  • Future research should explore strategies to minimize interventions for febrile infants without a source.
Abstract

Keywords:
adherencefebrile infantsguidelinelumbar punctureserious bacterial infection

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