C‐reactive protein concentrations can help to determine which febrile infants under three months should receive blood cultures during influenza seasons

Li, Wei-ran; Luo, Shuanghong; Zhu, Yu; Yang, Wen; Shu, Min; Wan, Chaomin

doi:10.1111/apa.14022

Cited by 5 publications

(3 citation statements)

References 26 publications

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“…However, many algorithms for the evaluation of febrile infants combine subjective clinical findings and laboratory markers using pre-existing numerical cutoffs rather than statistically derived values and lack precision and specificity, and validation studies have less than ideal accuracy . Biomarkers, such as C-reactive protein and procalcitonin, have been used either alone or combined with other laboratory and clinical findings to risk stratify febrile infants, but further assessment is necessary to identify optimal thresholds and determine their utility for inclusion in prediction rules. We sought to derive and validate an accurate prediction rule in a large, prospectively enrolled, geographically diverse cohort of febrile infants 60 days and younger to identify those at low risk of SBIs.…”

Section: Introductionmentioning

confidence: 99%

A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections

et al. 2019

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for the Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN) IMPORTANCE In young febrile infants, serious bacterial infections (SBIs), including urinary tract infections, bacteremia, and meningitis, may lead to dangerous complications. However, lumbar punctures and hospitalizations involve risks and costs. Clinical prediction rules using biomarkers beyond the white blood cell count (WBC) may accurately identify febrile infants at low risk for SBIs.OBJECTIVE To derive and validate a prediction rule to identify febrile infants 60 days and younger at low risk for SBIs. DESIGN, SETTING, AND PARTICIPANTS Prospective, observational study between March 2011 and May 2013 at 26 emergency departments. Convenience sample of previously healthy febrile infants 60 days and younger who were evaluated for SBIs. Data were analyzed between April 2014 and April 2018.EXPOSURES Clinical and laboratory data (blood and urine) including patient demographics, fever height and duration, clinical appearance, WBC, absolute neutrophil count (ANC), serum procalcitonin, and urinalysis. We derived and validated a prediction rule based on these variables using binary recursive partitioning analysis. MAIN OUTCOMES AND MEASURESSerious bacterial infection, defined as urinary tract infection, bacteremia, or bacterial meningitis. RESULTSWe derived the prediction rule on a random sample of 908 infants and validated it on 913 infants (mean age was 36 days, 765 were girls [42%], 781 were white and non-Hispanic [43%], 366 were black [20%], and 535 were Hispanic [29%]). Serious bacterial infections were present in 170 of 1821 infants (9.3%), including 26 (1.4%) with bacteremia, 151 (8.3%) with urinary tract infections, and 10 (0.5%) with bacterial meningitis; 16 (0.9%) had concurrent SBIs. The prediction rule identified infants at low risk of SBI using a negative urinalysis result, an ANC of 4090/μL or less (to convert to ×10 9 per liter, multiply by 0.001), and serum procalcitonin of 1.71 ng/mL or less. In the validation cohort, the rule sensitivity was 97.7% (95% CI, 91.3-99.6), specificity was 60.0% (95% CI, 56.6-63.3), negative predictive value was 99.6% (95% CI, 98.4-99.9), and negative likelihood ratio was 0.04 (95% CI, 0.01-0.15). One infant with bacteremia and 2 infants with urinary tract infections were misclassified. No patients with bacterial meningitis were missed by the rule. The rule performance was nearly identical when the outcome was restricted to bacteremia and/or bacterial meningitis, missing the same infant with bacteremia. CONCLUSIONS AND RELEVANCEWe derived and validated an accurate prediction rule to identify febrile infants 60 days and younger at low risk for SBIs using the urinalysis, ANC, and procalcitonin levels. Once further validated on an independent cohort, clinical application of the rule has the potential to decrease unnecessary lumbar punctures, antibiotic administration, and hospitalizations.

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Section: Introductionmentioning

confidence: 99%

A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections

et al. 2019

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“…Moreover, infants with bacteremia, particularly those aged less than 60 days, had significantly higher CRP levels than those without bacteremia. Previous studies have also reported that CRP levels may be an indicator of bacteremia in young infants and children [ 12 , 13 ]. Therefore, we believe that CRP levels could serve as a useful predictor of bacteremia in young febrile infants.…”

Section: Discussionmentioning

confidence: 99%

Predictors of bacteremia in febrile infants under 3 months old in the pediatric emergency department

Guo,

Chen,

Chang

et al. 2023

BMC Pediatr

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Introduction Fever may serve as the primary indicator of underlying infection in children admitted to the pediatric emergency department (PED), especially in high-risk young infants. This study aimed to identify early clinical factors that could help predict bacteremia in young febrile infants. Methods The study included infants under 90 days of age who were admitted to the PED due to fever. Patients were divided into two groups based on the presence or absence of bacteremia and further divided into three age groups: (1) less than 30 days, (2) 30 to 59 days, and (3) 60 to 90 days. Several clinical and laboratory variables were analyzed, and logistic regression and receiver operating characteristic (ROC) analyses were used to identify potential risk factors associated with bacteremia in young febrile infants. Results A total of 498 febrile infants were included, of whom 6.4% were diagnosed with bacteremia. The bacteremia group had a higher body temperature (BT) at triage, especially in neonates, higher pulse rates at triage, longer fever subsidence time, longer hospital stays, higher neutrophil counts, and higher C-reactive protein (CRP) levels than those of the non-bacteremia group. ROC analysis showed that the best cut-off values for predicting bacteremia in infants with pyrexia were a BT of 38.7 °C, neutrophil count of 57.9%, and CRP concentration of 53.8 mg/L. Conclusions A higher BT at triage, increased total neutrophil count, and elevated CRP levels may be useful for identifying bacteremia in young febrile infants admitted to the PED.

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“…Based on their work, the CRP determinant was the most important predictor of safe discharge. In another survey, Li and co-workers found that CRP levels could indicate which febrile children under three months of age should undertake blood culture tests during influenza seasons 28 . In the present study, we reported a significant difference between the levels of CRP in the three groups of influenza patients (P<0.05).…”

Section: Discussionmentioning

confidence: 99%

Comparison of clinical, serological, and radiological findings among hospitalized A-H1N1, B-H1N1, and H3N2 influenza patients

Shirani¹,

Hosseini²,

Ataei³

et al. 2020

Preprint

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Background: Despite remarkable developments in medical science, viral infections still remain serious threats to the global health system. Methods: In this cross-sectional study, we retrospectively compared the clinical, serological, and radiological findings in subjects with confirmed A-H1N1, B- H1N1, or A-H3N2 virus infection. The investigation included data on influenza patients who were admitted to the Al-Zahra Hospital, Isfahan, Iran, from September 2017 to February 2018. Results and Conclusions: Based on statistical analysis, fever was present as the most common clinical manifestation in patients with the three subtypes of influenza. Notably, the fever temperature was much higher among A-H3N2 subjects than A-H1N1 and B-H1N1 subjects (P<0.05). The A-H3N2 patients also had significantly higher C-reactive protein (CRP) levels than the other two groups of influenza patients (P<0.05). In the chest computed tomography scans, patchy infiltration and middle lobe involvement were found more commonly among A-H3N2 patients (P=0.012 and P=0.021, respectively) than patients of the other two influenza subtypes. Our clinical observations, serological examinations, and radiological findings are likely to be beneficial in managing patients with influenza and determining the need for further interventions.

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C‐reactive protein concentrations can help to determine which febrile infants under three months should receive blood cultures during influenza seasons

Abstract: We found that CRP concentrations could indicate which febrile children under three months of age should undergo blood culture tests during influenza seasons.

Cited by 5 publications

References 26 publications

A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections

A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections

Predictors of bacteremia in febrile infants under 3 months old in the pediatric emergency department

Comparison of clinical, serological, and radiological findings among hospitalized A-H1N1, B-H1N1, and H3N2 influenza patients

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