Risk Factors for Serious Bacterial Infection in Febrile Young Infants in a Community Referral Hospital

Abstract

Differentiation of serious bacterial infection (SBI) from self-limiting viral illness in febrile infants younger than three months is a significant challenge for clinicians. We aimed to assess the risk factors for SBI in febrile infants. Data were obtained from 221 infants younger than three months who visited a single community referral hospital for fever and underwent a complete sepsis workup between August 2003 and July 2006. The causes of fever were febrile illness without a documented cause (FISDC, 65%), urinary tract infection (UTI, 12%), aseptic meningitis (12%), bacteremia (4%), bacterial meningitis (2%). Cerebrospinal fluid enterovirus polymerase chain reaction was positive in 28% of FISDC and 48% of aseptic meningitis cases. When UTI was excluded, the risk factors for SBI were 1) C-reactive protein (CRP) level of ≥1.87 mg/dL and 2) fevers of ≥38.9℃. The specificity and negative predictive values of risk factors 1) and 2) for the diagnosis of SBI were 94% and 95%, respectively. We concluded that enteroviral infection may be a major cause of febrile episodes in infants younger than three months. If UTI could be excluded, the presence of CRP levels ≥1.87 mg/dL and fevers of ≥38.9℃ can be used as criteria to rule out SBI in these infants.

Enteroviral meningitis without pleocytosis in children

“…The absence of CSF pleocytosis has been reported in pediatric enteroviral CNS infections since RT-PCR method was first applied for the detection of EVs in the early 2000s 4–6 21. Although those studies4–6 21 included a number of age groups, the proportion of cases without pleocytosis in enteroviral meningitis among infants younger than 3 months was around 30% (30% of infants under 2 months in New Zealand4 and Missouri (USA)6, 31% in Pennsylvania (USA)5, and 28% of infants under 3 months in Korea 21…”

New prediction model for diagnosis of bacterial infection in febrile infants younger than 90 days

“…These findings imply that male gender is a risk factor for the development of SBI in infants up to 90 days old. Other authors suggest a similar conclusion 1,22,[25][26][27] , so it is important to take gender into consideration during the evaluation of febrile infants. Although most studies found no link between gender and SBI 10,12,20,[28][29][30][31] , that discrepancy should be considered from the epidemiological and population point of view.…”

“…Fever is among the most frequent reasons for bringing children to the Emergency Department, especially infants during the first three months of life 1 . It is also the main reason for, often unrealistic and exaggerated, parental concern 2 .…”

Etiology and Causative Pathogens of Febrile Neonates

“…Pathogens of UTI were E. coli in 81% and K. pneumoniae in 19% in infants less than 3 months [20]. In febril neonates, the most common uropathogens were found Escherichia coli (71%), Enterococcus (10%) and Klebsiella sp.…”

“…Infants less than 3 months with bacteremia, 54% were caused by group B Streptococus, 23% by E. coli [20]. There are not a sufficient source for pathogens causing bacterial infections in only febrile newborns.…”