OBJECTIVES: (1) To assess the rate of bacteremia in febrile infants less than 3 months of age admitted to a pediatric emergency department at a tertiary hospital; (2) to describe the bacteria isolated; and (3) to analyze factors related to increased probability of having a positive blood culture. METHODS: A retrospective, cross-sectional, 5-year descriptive study that includes all infants less than 3 months of age who presented with fever without source (FWS) and had a blood culture performed. RESULTS: A blood culture was performed in 1018 (91.5%) of 1125 infants admitted, and a bacterial pathogen was grown in 23 (2.2%) of these; 8 were associated with a positive urine culture. The most frequently isolated pathogen was Escherichia coli (9), followed by Streptococcus pneumoniae (4). The risk factors detected by multivariate analysis were: (a) being classified as "not well-appearing" (12.5% vs. 1.8%; odds ratio: 8.37) and (b) leukocyturia and/or nitrituria in a urine dipstick test (5.6% vs. 1.6%; odds ratio: 3.73). C-reactive protein value was higher than white blood cell count and absolute neutrophil count in detecting bacteremia; a 70 g/L cut-off had a specificity of 93.8%, but sensitivity of only 69.6%. CONCLUSIONS: A positive blood culture rate of 2.2% was found in infants less than 3 months of age with FWS. C-reactive protein, white blood cell count, and absolute neutrophil count were not good bacteremia predictors. We recommend obtaining a blood culture in infants less than 3 months of age with FWS, particularly those patients considered "not well-appearing" and those with leukocyturia and/or nitrituria.
OBJECTIVES: (1) To assess the rate of bacteremia in febrile infants less than 3 months of age admitted to a pediatric emergency department at a tertiary hospital; (2) to describe the bacteria isolated; and (3) to analyze factors related to increased probability of having a positive blood culture. METHODS: A retrospective, cross-sectional, 5-year descriptive study that includes all infants less than 3 months of age who presented with fever without source (FWS) and had a blood culture performed. RESULTS: A blood culture was performed in 1018 (91.5%) of 1125 infants admitted, and a bacterial pathogen was grown in 23 (2.2%) of these; 8 were associated with a positive urine culture. The most frequently isolated pathogen was Escherichia coli (9), followed by Streptococcus pneumoniae (4). The risk factors detected by multivariate analysis were: (a) being classified as "not well-appearing" (12.5% vs. 1.8%; odds ratio: 8.37) and (b) leukocyturia and/or nitrituria in a urine dipstick test (5.6% vs. 1.6%; odds ratio: 3.73). C-reactive protein value was higher than white blood cell count and absolute neutrophil count in detecting bacteremia; a 70 g/L cut-off had a specificity of 93.8%, but sensitivity of only 69.6%. CONCLUSIONS: A positive blood culture rate of 2.2% was found in infants less than 3 months of age with FWS. C-reactive protein, white blood cell count, and absolute neutrophil count were not good bacteremia predictors. We recommend obtaining a blood culture in infants less than 3 months of age with FWS, particularly those patients considered "not well-appearing" and those with leukocyturia and/or nitrituria.
Authors: R Velasco; B Gómez; S Hernández-Bou; I Olaciregui; M de la Torre; A González; A Rivas; I Durán; A Rubio Journal: Eur J Clin Microbiol Infect Dis Date: 2016-10-05 Impact factor: 3.267
Authors: Luregn J Schlapbach; Rolf Graf; Andreas Woerner; Matteo Fontana; Urs Zimmermann-Baer; David Glauser; Eric Giannoni; Thierry Roger; Christoph Müller; Mathias Nelle; Martin Stocker Journal: Intensive Care Med Date: 2013-01-08 Impact factor: 17.440
Authors: Christopher M Pruitt; Mark I Neuman; Samir S Shah; Veronika Shabanova; Christopher Woll; Marie E Wang; Elizabeth R Alpern; Derek J Williams; Laura Sartori; Sanyukta Desai; Rianna C Leazer; Richard D Marble; Russell J McCulloh; Adrienne G DePorre; Sahar N Rooholamini; Catherine E Lumb; Fran Balamuth; Sarah Shin; Paul L Aronson Journal: J Pediatr Date: 2018-10-05 Impact factor: 4.406