Severe bacterial infection in young infants with pyrexia admitted to the emergency department

Chen, Yinting; Chang, Yu-Jun; Liu, Bang-Yan; Lee, En-Pei; Wu, Han-Ping

doi:10.1097/md.0000000000026596

Cited by 3 publications

(2 citation statements)

References 33 publications

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“…Interestingly, we noted that an elevated neutrophil count was associated with a lower risk of bacterial co-infection. This was inconsistent with previous studies [16–18] and could be explained by the distribution of neutrophil counts in hospitalised children infected with HAdV. Therefore, elevated ferritin levels in hospitalised children infected with HAdV was considered as high-risk of chlamydia co-infection, while elevated WBC level was regarded as high-risk of bacterial co-infection.…”

Section: Discussioncontrasting

confidence: 66%

Identified risk factors for co-infection in hospitalised children infected with adenovirus in Hangzhou

et al. 2022

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This study aimed to describe the clinical manifestations of adenovirus infections and identify potential risk factors for co-infection with chlamydia, viruses and bacteria in hospitalised children from Hangzhou, China. From January to December 2019, the characteristics of hospitalised children infected with adenovirus at Hangzhou Children's Hospital and Zhejiang Xiaoshan Hospital were collected. The clinical factors related to co-infection with chlamydia, viruses and bacteria were assessed using multivariate logistic regression analyses. A total of 5989 children were infected with adenovirus, of which 573 were hospitalised for adenovirus infection. The severity of adenovirus respiratory infection was categorised as follows: mild (bronchiolitis, 73.6%), moderate (bronchopneumonia, 17.6%) or severe (pneumonia, 8.8%). Of the 573 children who were hospitalised, 280 presented with co-infection of chlamydia, viruses or bacteria, while the remaining 293 had only adenovirus infection. Multivariate stepwise logistic regression analyses indicated that elevated ferritin was associated with an increased risk of chlamydia co-infection (odds ratio (OR) 6.50; 95% confidence interval (CI) 1.56–27.11; P = 0.010). However, increased white blood cell (WBC) count was associated with a reduced risk of viral co-infection (OR 0.84; 95% CI 0.75–0.95; P = 0.006). The study indicated that co-infection with chlamydia could be affected by elevated ferritin levels. WBC levels could affect viral co-infection in hospitalised children infected with adenovirus.

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Section: Discussioncontrasting

confidence: 66%

Identified risk factors for co-infection in hospitalised children infected with adenovirus in Hangzhou

et al. 2022

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“…This is consistent with previously reported studies. 10,18,19 We found that CRP and PCT as single biomarkers were strong predictors of SBIs and IBIs. In line with the findings of previous studies, 6,20,21 CRP ≥20mg/L performed best in predicting SBIs with an AUC of 0.741.…”

Section: Discussionmentioning

confidence: 79%

Validation and comparison of the PECARN rule, Step-by-Step approach and Lab-score for predicting serious and invasive bacterial infections in young febrile infants

Sutiman

Khoo

Ong

et al. 2022

Ann Acad Med Singap

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Introduction: Differentiating infants with serious bacterial infections (SBIs) or invasive bacterial infections (IBIs) from those without remains a challenge. We sought to compare the diagnostic performances of single biomarkers (absolute neutrophil count [ANC], C-reactive protein [CRP] and procalcitonin [PCT]) and 4 diagnostic approaches comprising Lab-score, Step-by-Step approach (original and modified) and Pediatric Emergency Care Applied Research Network (PECARN) rule. Method: This is a prospective cohort study involving infants 0–90 days of age who presented to an emergency department from July 2020 to August 2021. SBIs were defined as bacterial meningitis, bacteraemia and/or urinary tract infections. IBIs were defined as bacteraemia and/or bacterial meningitis. We evaluated the performances of Lab-score, Step-by-Step (original and modified) and PECARN rule in predicting SBIs and IBIs. Results: We analysed a total of 258 infants, among whom 86 (33.3%) had SBIs and 9 (3.5%) had IBIs. In predicting SBIs, ANC ≥4.09 had the highest sensitivity and negative predictive value (NPV), while PCT ≥1.7 had the highest specificity and positive predictive value (PPV). CRP ≥20 achieved the highest area under receiver operating characteristic curve (AUC) of 0.741 (95% confidence interval [CI] 0.672–0.810). The Step-by-Step (original) approach had the highest sensitivity (97.7%). Lab-score had the highest AUC of 0.695 (95% CI 0.621–0.768), compared to PECARN rule at 0.625 (95% CI 0.556–0.694) and Step-by-Step (original) at 0.573 (95% CI 0.502–0.644). In predicting IBIs, PCT ≥1.7 had the highest sensitivity, specificity, PPV and NPV. The Step-by-Step (original and modified) approach had the highest sensitivity of 100%. Lab-score had the highest AUC of 0.854 (95% CI 0.731–0.977) compared to PECARN rule at 0.589 (95% CI 0.420–0.758) and Step-by-Step at 0.562 (95% CI 0.392–0.732). Conclusion: CRP strongly predicted SBIs, and PCT strongly predicted IBI. The Step-by-Step approach had the highest sensitivity and NPV, while Lab-score had the highest specificity and AUC in predicting SBIs and IBIs. Keywords: Biomarkers, diagnostic approaches, febrile infants, Lab-score, PECARN rule, Step-by-Step approach

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Detection of enterovirus in cerebrospinal fluids without pleocytosis in febrile infants under 3 months old reduces antibiotherapy duration

Blachez

Boussier²,

Mariani³

et al. 2023

Front. Pediatr.

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BackgroundInfants under 3 months old with fever often receive empirical antibiotic treatment. Enterovirus is one of the leading causes of infection and aseptic meningitis but is not systematically screened. We aimed to evaluate enterovirus positive RT-PCR proportion in cerebrospinal fluid (CSF) with no pleocytosis and its impact on antibiotic treatment duration.MethodsDuring the enterovirus endemic season, from 2015 to 2018, we retrospectively studied infants under 3 months old, consulting for fever without cause, with normal CSF analysis, and receiving empirical antibiotic treatment. Clinical and biological data were analyzed, notably enterovirus RT-PCR results. The primary outcome was the duration of antibiotic therapy.Results92 patients were recruited. When tested, 41% of infants were positive for enterovirus, median antibiotic duration was reduced in enterovirus positive in comparison to negative patients with respectively 1.9 [interquartile range (IQR), 1.7–2] vs. 4.1 [IQR, 2–6], p < 0.001. No clinical nor biological features differed according to the enterovirus status.ConclusionIn this population, enterovirus positive CSF are frequent despite the absence of pleocytosis. However, its research was not guided by clinical or biological presentations. Systematic and routine use of enterovirus RT-PCR during enterovirus season, regardless of CSF cell count, could reduce the prescription of antibiotics in febrile infants under 3 months old without clinical orientation.

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Severe bacterial infection in young infants with pyrexia admitted to the emergency department

Cited by 3 publications

References 33 publications

Identified risk factors for co-infection in hospitalised children infected with adenovirus in Hangzhou

Identified risk factors for co-infection in hospitalised children infected with adenovirus in Hangzhou

Validation and comparison of the PECARN rule, Step-by-Step approach and Lab-score for predicting serious and invasive bacterial infections in young febrile infants

Detection of enterovirus in cerebrospinal fluids without pleocytosis in febrile infants under 3 months old reduces antibiotherapy duration

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