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Febrile infants: predictors of bacteremia
Insights
A combination of clinical impression of sepsis, elevated white blood cell count, and high erythrocyte sedimentation rate can effectively predict bacteremia in febrile infants under 8 weeks old. This approach accurately identified all bacteremic infants while excluding most non-bacteremic cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neonatal Care
Background:
- Febrile infants under 8 weeks old present a diagnostic challenge for identifying serious bacterial infections like bacteremia.
- Early and accurate diagnosis is crucial to guide appropriate antibiotic therapy and improve outcomes.
Purpose of the Study:
- To identify early clinical and laboratory predictors of bacteremia in infants less than 8 weeks of age presenting with fever.
- To evaluate the effectiveness of a combined predictive model for bacteremia in this vulnerable population.
Main Methods:
- Prospective study of 175 infants (<8 weeks) with rectal temperature ≥38°C.
- Clinical assessment including physician's impression, white blood cell count, band count, and erythrocyte sedimentation rate were recorded.
- Lumbar puncture and blood cultures were performed; infants received antibiotics pending results.
Main Results:
- Overall incidence of bacteremia was 3.4%.
- No single variable (WBC count, band count, temperature, irritability, tone, cry, activity) reliably predicted bacteremia.
- Erythrocyte sedimentation rate (ESR) ≥30 and impression of sepsis were associated with bacteremia.
- A combination of impression of sepsis, WBC count ≥15,000/mm³, and ESR ≥30 identified all bacteremic infants and excluded 82% of non-bacteremic infants.
Conclusions:
- A combination of clinical impression of sepsis, elevated white blood cell count, and elevated erythrocyte sedimentation rate is a highly effective predictor of bacteremia in febrile infants.
- This multi-variable approach improves diagnostic accuracy, aiding in timely and appropriate management of febrile neonates.
Abstract:
One hundred and seventy-five infants less than 8 weeks of age, presenting to the pediatric emergency room of the Bronx Municipal Hospital Center with rectal temperature greater than or equal to 38 degrees C (100.4 degrees F), were studied. House officers recorded their impressions of the infants on a number of variables prior to performing a lumbar puncture and obtaining laboratory data. All infants were admitted for parenteral antibiotic therapy pending culture results. Culture-positive bacterial infections occurred in 6.3% (n = 11); the incidence of bacteremia was 3.4% (n = 6). Of special concern were the 134 infants who had no visible source for their fever during the first examination. A major goal was to determine whether there were any early predictors of bacteremia in this group. The individual variables of white blood cell count greater than or equal to 15,000/mm3, band count greater than or equal to 500/mm3, temperature, impression of irritability, tone, cry, and activity level were not related to the presence of bacteremia. An erythrocyte sedimentation rate greater than or equal to 30 and the examiner's impression of sepsis were significantly associated with bacteremia but did not correctly identify all cases. However, the combination of impression of sepsis, white blood count greater than or equal to 15,000/mm3, and erythrocyte sedimentation rate greater than or equal to 30 identified all infants with bacteremia and excluded 82% of the infants who were eventually shown not to have bacteremia.