Anna R Huppler1, Jens C Eickhoff, Ellen R Wald. 1. University of Wisconsin-Madison, Department of Pediatrics, 600 Highland Ave, Madison, WI 53792, USA. hupplerar@upmc.edu
Abstract
OBJECTIVE: The goal was to determine the performance of low-risk criteria for serious bacterial illnesses (SBIs) in febrile infants in prospective studies in which empiric antibiotic treatment was withheld, compared with studies (prospective and retrospective) in which empiric antibiotic treatment was administered. METHODS: A search of the English-language literature was undertaken by using a PubMed database and reference lists of relevant studies of fever, low-risk criteria, and SBIs. Studies of infants >90 days of age, infants with specific infections, or infants with additional risk factors for infection were excluded. Publications were categorized as retrospective, prospective with empiric antibiotic treatment for all patients, or prospective with antibiotics withheld. The relative risk of SBI in high-risk versus low-risk patients was determined for pooled data in each category. The rates of SBIs in low-risk patients in each category were compared. RESULTS: Twenty-one studies met the inclusion criteria. In prospective studies in which patients were cared for without empiric antibiotic treatment, 6 patients assigned to the low-risk category had SBIs; all recovered uneventfully. The rate of SBIs in these low-risk patients was 0.67%. The relative risk of SBIs in high-risk versus low-risk patients in these studies was 30.56 (95% confidence interval: 7.0-68.13). The rate of SBIs in low-risk patients in all studies was 2.23%. The rate of SBIs in low-risk patients in the prospective studies without empiric antibiotic treatment was significantly different from the rate in all other studies (0.67% vs 2.71%; P = .01). CONCLUSIONS: Low-risk criteria perform well in prospective studies in which empiric antibiotic treatment is withheld. These criteria allow approximately 30% of young febrile infants to be observed without antibiotic treatment, thus avoiding unnecessary hospitalization, nosocomial infection, injudicious use of antibiotics, and adverse effects of antibiotics.
OBJECTIVE: The goal was to determine the performance of low-risk criteria for serious bacterial illnesses (SBIs) in febrile infants in prospective studies in which empiric antibiotic treatment was withheld, compared with studies (prospective and retrospective) in which empiric antibiotic treatment was administered. METHODS: A search of the English-language literature was undertaken by using a PubMed database and reference lists of relevant studies of fever, low-risk criteria, and SBIs. Studies of infants >90 days of age, infants with specific infections, or infants with additional risk factors for infection were excluded. Publications were categorized as retrospective, prospective with empiric antibiotic treatment for all patients, or prospective with antibiotics withheld. The relative risk of SBI in high-risk versus low-risk patients was determined for pooled data in each category. The rates of SBIs in low-risk patients in each category were compared. RESULTS: Twenty-one studies met the inclusion criteria. In prospective studies in which patients were cared for without empiric antibiotic treatment, 6 patients assigned to the low-risk category had SBIs; all recovered uneventfully. The rate of SBIs in these low-risk patients was 0.67%. The relative risk of SBIs in high-risk versus low-risk patients in these studies was 30.56 (95% confidence interval: 7.0-68.13). The rate of SBIs in low-risk patients in all studies was 2.23%. The rate of SBIs in low-risk patients in the prospective studies without empiric antibiotic treatment was significantly different from the rate in all other studies (0.67% vs 2.71%; P = .01). CONCLUSIONS: Low-risk criteria perform well in prospective studies in which empiric antibiotic treatment is withheld. These criteria allow approximately 30% of young febrile infants to be observed without antibiotic treatment, thus avoiding unnecessary hospitalization, nosocomial infection, injudicious use of antibiotics, and adverse effects of antibiotics.
Authors: Paul L Aronson; Cary Thurm; Derek J Williams; Lise E Nigrovic; Elizabeth R Alpern; Joel S Tieder; Samir S Shah; Russell J McCulloh; Fran Balamuth; Amanda C Schondelmeyer; Evaline A Alessandrini; Whitney L Browning; Angela L Myers; Mark I Neuman Journal: J Hosp Med Date: 2015-02-13 Impact factor: 2.960
Authors: Paul L Aronson; Marie E Wang; Eugene D Shapiro; Samir S Shah; Adrienne G DePorre; Russell J McCulloh; Christopher M Pruitt; Sanyukta Desai; Lise E Nigrovic; Richard D Marble; Rianna C Leazer; Sahar N Rooholamini; Laura F Sartori; Fran Balamuth; Christopher Woll; Mark I Neuman Journal: Pediatrics Date: 2018-11-13 Impact factor: 7.124
Authors: Prashant Mahajan; Nathan Kuppermann; Asuncion Mejias; Nicolas Suarez; Damien Chaussabel; T Charles Casper; Bennett Smith; Elizabeth R Alpern; Jennifer Anders; Shireen M Atabaki; Jonathan E Bennett; Stephen Blumberg; Bema Bonsu; Dominic Borgialli; Anne Brayer; Lorin Browne; Daniel M Cohen; Ellen F Crain; Andrea T Cruz; Peter S Dayan; Rajender Gattu; Richard Greenberg; John D Hoyle; David M Jaffe; Deborah A Levine; Kathleen Lillis; James G Linakis; Jared Muenzer; Lise E Nigrovic; Elizabeth C Powell; Alexander J Rogers; Genie Roosevelt; Richard M Ruddy; Mary Saunders; Michael G Tunik; Leah Tzimenatos; Melissa Vitale; J Michael Dean; Octavio Ramilo Journal: JAMA Date: 2016 Aug 23-30 Impact factor: 56.272
Authors: Paul L Aronson; Derek J Williams; Cary Thurm; Joel S Tieder; Elizabeth R Alpern; Lise E Nigrovic; Amanda C Schondelmeyer; Fran Balamuth; Angela L Myers; Russell J McCulloh; Evaline A Alessandrini; Samir S Shah; Whitney L Browning; Katie L Hayes; Elana A Feldman; Mark I Neuman Journal: J Hosp Med Date: 2015-08-06 Impact factor: 2.960