A predictive model to estimate the risk of serious bacterial infections in febrile infants

Abstract

CRP, duration of fever, the "standardized clinical impression score", a history of diarrhoea and focal signs of infection were the independent, most powerful predictors of SBI in febrile infants, identified by logistic regression analysis. Although the predictive model is not validated for direct clinical use, it illustrates the clinical potential of the used technique. This technique offers the advantage of assess the probability of SBI in every individual infant. This probability will form the best basis for well-founded decisions in the management of the individual febrile infant.

Updated Review of Blood Culture Contamination

“…In one study that used blinded assessments by infectious disease experts to determine the presence of true bacteremia, catheter-drawn cultures had a VOL. 19,2006 UPDATED REVIEW OF BLOOD CULTURE CONTAMINATION 793 sensitivity of 89%, compared to 78% for peripheral cultures, with a positive predictive value of 63% for catheter-drawn cultures versus 73% for percutaneous cultures (34). The results of that study were similar to those of other studies, leading many to suggest that if cultures are obtained from a catheter, at least one set should be drawn percutaneously (13,20,38,74,76,92).…”

“…Although controversial, some experts recommend that the culture site be prepped with 70% isopropyl or ethyl alcohol and allowed to air dry and that a VOL. 19,2006 UPDATED REVIEW OF BLOOD CULTURE CONTAMINATION 795…”

“…As described above, single blood cultures are particularly common in pediatric patients; this fact, combined with the increased utilization of catheter-based culture specimens, makes discrimination between true bacteremia and contamination challenging, particularly when coagulase-negative staphylococci are grown in culture (24). To combat this challenge, investigators have explored multiple avenues, including the use of C-reactive protein, time to positivity, quantity of growth, and clinical status (3,18,19,32,44,98,110,129). While none of these factors have performed well enough individually to warrant widespread adoption, they continue to be under investigation.…”

Translation of clinical prediction rules for febrile children to primary care practice: an observational cohort study

“…6,[18][19][20][21][22][23] Variables of the selected CPRs were matched with the alarm signs in the GPC-dataset. In case alarm signs were not entirely identical to the original CPR variables, best proxy variables were used.…”

Use of alarm features in referral of febrile children to the emergency department: an observational study

“…Clinical prediction rules may, alongside guidelines, help physicians to identify children at low risk of disease. [19][20][21][22][23][24][25] The only clinical prediction rule developed for primary care specifically showed a promising high sensitivity and low negative likelihood ratio at derivation; 6 however, it lacked generalisability on external validation in other low-prevalence populations. 17 In addition, another study has shown that other clinical prediction rules developed for hospital emergency care were of limited use in the primary outof-hours care setting as well.…”