Rates of positive blood, urine, and cerebrospinal fluid cultures in children younger than 60 days during the vaccination era.
ABSTRACT Fever is a common reason children present to the emergency department. The goal of this study was to determine the rates and the etiology of bacterial infection in children younger than 2 months during the vaccination era.
This is a retrospective chart review performed at a tertiary care hospital. Electronic medical records were used to identify patients who had a workup for fever/sepsis in the emergency department. The search was limited to identifying only children younger than 60 days.
A total of 207 patients satisfied the inclusion/exclusion criteria. In children younger than 28 days, the blood culture-positive rate was 2.7% (range, 0.0%-6.4%), the urine culture-positive rate was 10.7% (range, 3.5%-17.8%), and the cerebrospinal fluid-positive rate (excluding enteroviral infections) was 0% (range, 0.0%-3.9%). In children 29 to 60 days, the blood culture-positive rate was 1.5% (range, 0.0%-3.6%), urine culture-positive rate was 8.5% (range, 3.7%-13.3%), and the cerebrospinal fluid-positive rate (excluding enteroviral infections) was 1.7% (range, 0.0%-5.0%). Urinary tract infections due to Escherichia coli were very common, whereas no cases of Haemophilus influenzae and one case of Streptococcus pneumoniae were detected.
Urinary tract infections due to E. coli are very common in this age group. The classic pathogens H. influenzae and S. pneumoniae were essentially nonexistent in this study possibly because of herd immunity obtained through current vaccination practices.
Article: Fever in the pediatric patient.[Show abstract] [Hide abstract]
ABSTRACT: Fever is the most common reason that children and infants are brought to emergency departments. Emergency physicians face the challenge of quickly distinguishing benign from life-threatening conditions. The management of fever in children is guided by the patient's age, immunization status, and immune status as well as the results of a careful physical examination and appropriate laboratory tests and radiographic views. In this article, the evaluation and treatment of children with fevers of known and unknown origin are described. Causes of common and dangerous conditions that include fever in their manifestation are also discussed.Emergency medicine clinics of North America 11/2013; 31(4):1073-96. DOI:10.1016/j.emc.2013.07.006 · 0.85 Impact Factor
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ABSTRACT: Some authors have assessed the utility of considering various risk factors in predicting bacteremia in young infants with urinary tract infection (UTI) in studies that included only febrile patients. Our aims were to determine whether fever was a predictor for bacteremia and to identify other associated risk factors. A retrospective study was conducted that included infants 29 to 90 days of age with UTI who attended in the Pediatric Emergency Department from September 2006 through May 2013. UTI was defined as growth of ≥50000 colony-forming units/mL of a single pathogen from a catheterized specimen in association with an abnormal urinalysis. Patients without a blood culture were excluded. Univariate testing was used to identify clinical and laboratory factors associated with bacteremia. Receiver operating characteristic curves were constructed for the laboratory markers associated with bacteremia. We analyzed 350 patients; 77 (22%) were afebrile. Ten had bacteremia (2.9%, 95%CI: 1.6-5.2%). No other adverse events were identified. No differences were found in bacteremia rates between febrile and afebrile patients (2.9% vs 2.6%; p=1.0). Risk factors detected for bacteremia were classified as not well-appearing (25.0% vs 2.1%; p=0.003) and a PCT value ≥0.7ng/mL(6.4% vs 0.5%; p=0.001). These low risk criteria yielded a sensitivity of 88.9% for detecting bacteremia with a negative predictive value of 99.5%. Afebrile young infants with UTI should not be classified a priori as low risk for bacteremia. Well-appearing young infants with UTI and PCT value <0.7ng/mL were at very low risk for bacteremia; outpatient management with an appropriate follow-up could be considered.The Pediatric Infectious Disease Journal 12/2013; 33(3). DOI:10.1097/INF.0000000000000033 · 3.14 Impact Factor
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ABSTRACT: To determine the prevalence of outpatient-diagnosed urinary tract infection [UTI] in consecutive febrile neonates ≤ 30 days of age, and correlate demographic, laboratory and radiographic imaging results with infectious etiology. Review of medical records of consecutive febrile infants ≤ 30 days of age presenting to an urban pediatric emergency department during a 10-year period, whose policy is to perform a sepsis evaluation [urine culture obtained by bladder catheterization] and hospitalize for parenteral antibiotic therapy pending culture results. Of 670 febrile neonates ≤ 30 days of age evaluated for sepsis, urine culture was obtained in 651 cases [97%]. Of 100 patients with UTI [15.4%], 73% were male; the most common uropathogens were Escherichia coli [71%], Enterococcus [10%], and Klebsiella sp. [10%]. In all, 39% had a maximum documented fever ≥ 102F, and 40% had CBC total WBC count ≥ 15,000/mm. Urine dipstick test was positive for leukocyte esterase or nitrite in 79%. Renal ultrasound performed in 95 patients [95%] showed anatomic abnormalities in 47%; 5/26 [24%] with hydronephrosis had VUR on VCUG. Four patients with UTI had urosepsis; none had bacterial meningitis; no patients died. UTI affects approximately 1 in 6 febrile neonates ≤ 30 days of age. Males are affected 2.5-times greater than females. Escherichia coli continues to be the predominant uropathogen. Clinical parameters like height of fever, CBC total WBC count, and urine dipstick test lack sensitivity in identifying UTI risk in the outpatient setting. Nearly half of neonates with UTI have a radiographically-identified anatomic abnormality. All febrile young infants should receive performance of a urine culture; those with UTI require imaging.The Pediatric Infectious Disease Journal 10/2013; 33(4). DOI:10.1097/INF.0000000000000110 · 3.14 Impact Factor