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Management and Outcome of Febrile Infants ≤60 days, With Emphasis on Infants ≤21 Days Old, in Swedish Pediatric Emergency Departments

Orfanos, Ioannis LU orcid ; Elfving, Kristina LU ; Sotoca Fernandez, Jorge LU ; Wennlund, Lovisa ; Weiber, Sofia ; Eklund, Erik A LU and Alfvén, Tobias LU (2022) In Pediatric Infectious Disease Journal 41(7). p.537-543
Abstract

BACKGROUND: Management of febrile infants ≤60 days of age varies, and the age for routine investigations and antibiotic-treatment is debated. The American Academy of Pediatrics recommended age threshold for lumbar puncture (LP) is 21 days and for blood culture 60 days. We describe management and adverse outcome of febrile infants ≤60 days old, in Sweden.

METHODS: Retrospective cross-sectional study of infants ≤60 days of age with fever without source evaluated in 4 University pediatric emergency departments, between 2014 and 2017. Adverse outcome was defined as delayed-treated invasive bacterial infection (IBI: meningitis or bacteremia).

RESULTS: We included 1701 infants. In infants ≤21 days old, LP was performed in 16% (95%... (More)

BACKGROUND: Management of febrile infants ≤60 days of age varies, and the age for routine investigations and antibiotic-treatment is debated. The American Academy of Pediatrics recommended age threshold for lumbar puncture (LP) is 21 days and for blood culture 60 days. We describe management and adverse outcome of febrile infants ≤60 days old, in Sweden.

METHODS: Retrospective cross-sectional study of infants ≤60 days of age with fever without source evaluated in 4 University pediatric emergency departments, between 2014 and 2017. Adverse outcome was defined as delayed-treated invasive bacterial infection (IBI: meningitis or bacteremia).

RESULTS: We included 1701 infants. In infants ≤21 days old, LP was performed in 16% (95% CI: 12-20) and blood culture in 43% (95% CI: 38-48). Meningitis was diagnosed in 5 (1.3%; 95% CI: 0.4-3.0) and bacteremia in 12 (4.5%; 95% CI: 2.6-7.0) infants. Broad-spectrum antibiotics were not administered to 66% (95% CI: 61-71), of which 2 (0.8%; 95% CI: 0.1-2.8) diagnosed with IBI (1 meningitis and 1 bacteremia). In the 29-60 days age group, blood culture was performed in 21% (95% CI: 19-24), and broad-spectrum antibiotics were not administered to 84% (95% CI: 82-86), with no case of delayed-treated bacteremia.

CONCLUSIONS: The rates of LP, blood culture and broad-spectrum antibiotics were low. Despite that, there were few delayed-treated IBIs, but 2 of the 17 infants ≤21 days of age with IBI were not timely treated, which prompts the need for a safer approach for this age group. Also, the utility of routine blood culture for all febrile infants 29-60 days old could be questioned.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Pediatric Infectious Disease Journal
volume
41
issue
7
pages
537 - 543
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:85131770435
  • pmid:35389959
ISSN
1532-0987
DOI
10.1097/INF.0000000000003542
project
Prevalence of serious bacterial infections and management of febrile infants ≤60 days in Swedish Pediatric Emergency Departments
language
English
LU publication?
yes
additional info
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
id
450e33f6-a038-4663-86bc-39dae99e6153
date added to LUP
2022-04-09 10:18:35
date last changed
2024-08-08 17:03:14
@article{450e33f6-a038-4663-86bc-39dae99e6153,
  abstract     = {{<p>BACKGROUND: Management of febrile infants ≤60 days of age varies, and the age for routine investigations and antibiotic-treatment is debated. The American Academy of Pediatrics recommended age threshold for lumbar puncture (LP) is 21 days and for blood culture 60 days. We describe management and adverse outcome of febrile infants ≤60 days old, in Sweden.</p><p>METHODS: Retrospective cross-sectional study of infants ≤60 days of age with fever without source evaluated in 4 University pediatric emergency departments, between 2014 and 2017. Adverse outcome was defined as delayed-treated invasive bacterial infection (IBI: meningitis or bacteremia).</p><p>RESULTS: We included 1701 infants. In infants ≤21 days old, LP was performed in 16% (95% CI: 12-20) and blood culture in 43% (95% CI: 38-48). Meningitis was diagnosed in 5 (1.3%; 95% CI: 0.4-3.0) and bacteremia in 12 (4.5%; 95% CI: 2.6-7.0) infants. Broad-spectrum antibiotics were not administered to 66% (95% CI: 61-71), of which 2 (0.8%; 95% CI: 0.1-2.8) diagnosed with IBI (1 meningitis and 1 bacteremia). In the 29-60 days age group, blood culture was performed in 21% (95% CI: 19-24), and broad-spectrum antibiotics were not administered to 84% (95% CI: 82-86), with no case of delayed-treated bacteremia.</p><p>CONCLUSIONS: The rates of LP, blood culture and broad-spectrum antibiotics were low. Despite that, there were few delayed-treated IBIs, but 2 of the 17 infants ≤21 days of age with IBI were not timely treated, which prompts the need for a safer approach for this age group. Also, the utility of routine blood culture for all febrile infants 29-60 days old could be questioned.</p>}},
  author       = {{Orfanos, Ioannis and Elfving, Kristina and Sotoca Fernandez, Jorge and Wennlund, Lovisa and Weiber, Sofia and Eklund, Erik A and Alfvén, Tobias}},
  issn         = {{1532-0987}},
  language     = {{eng}},
  number       = {{7}},
  pages        = {{537--543}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{Pediatric Infectious Disease Journal}},
  title        = {{Management and Outcome of Febrile Infants ≤60 days, With Emphasis on Infants ≤21 Days Old, in Swedish Pediatric Emergency Departments}},
  url          = {{http://dx.doi.org/10.1097/INF.0000000000003542}},
  doi          = {{10.1097/INF.0000000000003542}},
  volume       = {{41}},
  year         = {{2022}},
}