Background:The objective is to compare the prevalence of serious bacterial infection (SBI) and invasive bacterial infection (IBI) in febrile infants <60 days of age and in those between 61 and 90 days. Methods: Prospective registry-based cohort study including all the infants ≤90 days with fever without a source evaluated in a pediatric emergency department between 2003 and 2017. We compared the prevalence of SBI and IBI in febrile infants <60 days of age and those between 61 and 90 days. Results: We included 3,301 infants. Overall, 605 (18.3%) had a SBI (mainly urinary tract infection), of these 81 (2.5%) had an IBI (bacteremia 60, meningitis 12, sepsis 9). The prevalence of SBI in infants >60 days old was 18.5% (95% CI: 16.4-20.7) versus 16.6% (95% CI: 14.7-18.7; n.s.) in those between 29 and 60 days and versus 21.5% (95% CI: 18.6-24.7; n.s.) in those <28 days of age. The prevalence of IBI among infants >60 days old was 1.1% (95% CI: 0.6-2.2) versus 2.3% (95% CI: 1.6-3.3; P < 0.05) in those between 29 and 60 days and 5.1% (95% CI: 3.7-7.0; P < 0.05) in those <28 days of age. The prevalence of IBI in well appearing >60 days was 1.0% (versus 4.5% in those <28 days old, P < 0.01; and 2.0% in those between 29 and 60 days, P = 0.06). All bacterial meningitis, except one, were diagnosed in infants <28 days. Conclusions: The prevalence of IBI in febrile infants between 61 and 90 days of age is high enough to support the recommendation for obtaining urine and blood tests in this population.

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INTRODUCCIÓN: La apendicitis aguda (AA) es la patología quirúrgica urgente más frecuente en pediatría. La pandemia por la COVID-19 ha generado un descenso en las consultas a urgencias, pudiendo conllevar un retraso en la atención sanitaria y un aumento en la gravedad de las patologías. El objetivo es analizar la tasa de AA complicadas durante la pandemia, en comparación con el mismo periodo del año anterior. MATERIAL Y MÉTODOS: Estudio retrospectivo observacional de cohortes unicéntrico que incluyó a pacientes menores de 14 años atendidos en urgencias con diagnóstico de AA durante los meses de marzo a mayo de 2019 (no pandemia) y 2020 (pandemia). RESULTADOS: Se incluyeron 90 pacientes (41 en no pandemia y 49 en pandemia). No se encontraron diferencias en el tiempo desde el inicio de la clínica hasta la consulta en urgencias entre los dos períodos (37 h vs 38 h, p=0,881), pero sí en el tiempo desde la llegada a urgencias hasta la intervención quirúrgica (7:00 h vs 10:30 h; p=0,004). La diferencia se acentuó al comparar el mes de marzo con abril-mayo de 2020 (6h vs 12h; p=0,001). No se observaron diferencias significativas en la tasa de AA complicadas en el diagnóstico intraoperatorio (35% vs 33%; p=0,870) ni anatomopatólogico (35% vs 48%; p=0,222), ni tampoco en el número de complicaciones postoperatorias, duración de ingreso y reingresos. Se objetivó un aumento del diagnóstico anatomopatológico de AA con periapendicitis (47% vs 81%; p=0,001) CONCLUSIÓN: Durante la pandemia se observó una demora desde la llegada a urgencias hasta la intervención quirúrgica en niños diagnosticados de AA. Esta demora se tradujo en un incremento del diagnóstico de AA evolucionadas histológicamente, pero sin objetivarse un aumento de las complicaciones de la enfermedad.

ObjectiveTo analyse the impact of blood enterovirus and human parechovirus PCR (ev-PCR) testing in young infants with fever without a source (FWS).DesignObservational study, subanalysis of a prospective registry.SettingPaediatric emergency department.PatientsInfants ≤90 days of age with FWS seen between September 2015 and August 2019 with blood ev-PCR, blood and urine cultures and urine dipstick test performed.Main outcome measuresPrevalence of invasive bacterial infection (IBI: bacterial pathogen in blood or cerebrospinal fluid) in infants with positive or negative ev-PCR test results. Secondarily, we also compared length of stay and antibiotic treatment in hospitalised infants.ResultsOf 703 infants, 174 (24.7%) had a positive blood ev-PCR and none of them were diagnosed with an IBI (vs 2.6% (95% CI 1.3% to 4.0%) of those with a negative result, p=0.02). Prevalence of non-IBI (mainly urinary tract infection) was also lower among infants with a positive blood ev-PCR (2.3% (95% CI 0.1% to 4.5%) vs 17.6% (95% CI 14.3% to 20.8%), p<0.01).Overall, 258 infants were hospitalised (36.6%) and 193 (74.8%) of them received antibiotics. Length of hospital stay and antibiotic treatment were shorter in those with a positive blood ev-PCR (median: 3 days vs 5 days and 1 day vs 5 days, respectively; p<0.01). Differences remained statistically significant among well-appearing infants >21 days old with normal urine dipstick.ConclusionBlood ev-PCR identifies a group of infants under 90 days of age with FWS at very low risk of IBI. This test may help to guide clinical decision making in young febrile infants.