Lyubina C Yankova1, Mark I Neuman2,3, Marie E Wang4, Christopher Woll1, Adrienne G DePorre5, Sanyukta Desai6, Laura F Sartori7, Lise E Nigrovic2,3, Christopher M Pruitt8, Richard D Marble9, Rianna C Leazer10, Sahar N Rooholamini11, Fran Balamuth12, Paul L Aronson13,14. 1. Departments of Pediatrics and. 2. Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital. 3. Harvard Medical School, Harvard University, Boston, Massachusetts. 4. Division of Pediatric Hospital Medicine, Department of Pediatrics, Lucile Packard Children's Hospital Stanford, School of Medicine, Stanford University, Palo Alto, California. 5. Division of Hospital Medicine, Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri. 6. Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and College of Medicine, University of Cincinnati, Cincinnati, Ohio. 7. Division of Pediatric Emergency Medicine, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt and School of Medicine, Vanderbilt University, Nashville, Tennessee. 8. Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama. 9. Division of Emergency Medicine, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 10. Division of Hospital Medicine, Department of Pediatrics, Children's Hospital of The King's Daughters, Norfolk, Virginia. 11. Division of Hospital Medicine, Department of Pediatrics, Seattle Children's Hospital and School of Medicine, University of Washington, Seattle, Washington; and. 12. Division of Emergency Medicine and Center for Pediatric Clinical Effectiveness, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. 13. Departments of Pediatrics and paul.aronson@yale.edu. 14. Emergency Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut.
Abstract
OBJECTIVES: We aimed to describe the clinical and laboratory characteristics of febrile infants ≤60 days old with positive urinalysis results and invasive bacterial infections (IBI). METHODS: We performed a planned secondary analysis of a retrospective cohort study of febrile infants ≤60 days old with IBI who presented to 11 emergency departments from July 1, 2011, to June 30, 2016. For this subanalysis, we included infants with IBI and positive urinalysis results. We analyzed the sensitivity of high-risk past medical history (PMH) (prematurity, chronic medical condition, or recent antimicrobial receipt), ill appearance, and/or abnormal white blood cell (WBC) count (<5000 or >15 000 cells/μL) for identification of IBI. RESULTS: Of 148 febrile infants with positive urinalysis results and IBI, 134 (90.5%) had bacteremia without meningitis and 14 (9.5%) had bacterial meningitis (11 with concomitant bacteremia). Thirty-five infants (23.6%) with positive urinalysis results and IBI did not have urinary tract infections. The presence of high-risk PMH, ill appearance, and/or abnormal WBC count had a sensitivity of 53.4% (95% confidence interval: 45.0-61.6) for identification of IBI. Of the 14 infants with positive urinalysis results and concomitant bacterial meningitis, 7 were 29 to 60 days old. Six of these 7 infants were ill-appearing or had an abnormal WBC count. The other infant had bacteremia with cerebrospinal fluid pleocytosis after antimicrobial pretreatment and was treated for meningitis. CONCLUSIONS: The sensitivity of high-risk PMH, ill appearance, and/or abnormal WBC count is suboptimal for identifying febrile infants with positive urinalysis results at low risk for IBI. Most infants with positive urinalysis results and bacterial meningitis are ≤28 days old, ill-appearing, or have an abnormal WBC count.
OBJECTIVES: We aimed to describe the clinical and laboratory characteristics of febrile infants ≤60 days old with positive urinalysis results and invasive bacterial infections (IBI). METHODS: We performed a planned secondary analysis of a retrospective cohort study of febrile infants ≤60 days old with IBI who presented to 11 emergency departments from July 1, 2011, to June 30, 2016. For this subanalysis, we included infants with IBI and positive urinalysis results. We analyzed the sensitivity of high-risk past medical history (PMH) (prematurity, chronic medical condition, or recent antimicrobial receipt), ill appearance, and/or abnormal white blood cell (WBC) count (<5000 or >15 000 cells/μL) for identification of IBI. RESULTS: Of 148 febrile infants with positive urinalysis results and IBI, 134 (90.5%) had bacteremia without meningitis and 14 (9.5%) had bacterial meningitis (11 with concomitant bacteremia). Thirty-five infants (23.6%) with positive urinalysis results and IBI did not have urinary tract infections. The presence of high-risk PMH, ill appearance, and/or abnormal WBC count had a sensitivity of 53.4% (95% confidence interval: 45.0-61.6) for identification of IBI. Of the 14 infants with positive urinalysis results and concomitant bacterial meningitis, 7 were 29 to 60 days old. Six of these 7 infants were ill-appearing or had an abnormal WBC count. The other infant had bacteremia with cerebrospinal fluid pleocytosis after antimicrobial pretreatment and was treated for meningitis. CONCLUSIONS: The sensitivity of high-risk PMH, ill appearance, and/or abnormal WBC count is suboptimal for identifying febrile infants with positive urinalysis results at low risk for IBI. Most infants with positive urinalysis results and bacterial meningitis are ≤28 days old, ill-appearing, or have an abnormal WBC count.
Authors: Alan R Schroeder; Mark W Shen; Eric A Biondi; Michael Bendel-Stenzel; Clifford N Chen; Jason French; Vivian Lee; Rianna C Evans; Karen E Jerardi; Matt Mischler; Kelly E Wood; Pearl W Chang; Heidi K Roman; Tara L Greenhow Journal: Arch Dis Child Date: 2015-07-15 Impact factor: 3.791
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: Christopher Woll; Mark I Neuman; Christopher M Pruitt; Marie E Wang; Eugene D Shapiro; Samir S Shah; Russell J McCulloh; Lise E Nigrovic; Sanyukta Desai; Adrienne G DePorre; Rianna C Leazer; Richard D Marble; Fran Balamuth; Elana A Feldman; Laura F Sartori; Whitney L Browning; Paul L Aronson Journal: J Pediatr Date: 2018-05-18 Impact factor: 4.406
Authors: Marie E Wang; Eric A Biondi; Russell J McCulloh; Matthew D Garber; Beth C Natt; Brian P Lucas; Alan R Schroeder Journal: Pediatrics Date: 2019-08-08 Impact factor: 7.124
Authors: Roberto Velasco; Helvia Benito; Rebeca Mozún; Juan E Trujillo; Pedro A Merino; Santiago Mintegi; San Tiago Journal: Pediatr Infect Dis J Date: 2015-01 Impact factor: 2.129
Authors: Leah Tzimenatos; Prashant Mahajan; Peter S Dayan; Melissa Vitale; James G Linakis; Stephen Blumberg; Dominic Borgialli; Richard M Ruddy; John Van Buren; Octavio Ramilo; Nathan Kuppermann Journal: Pediatrics Date: 2018-01-16 Impact factor: 7.124
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