Risk factors for serious bacterial infection in febrile young infants in a community referral hospital.
Differentiation of serious bacterial infection (SBI) from self-limiting viral illness in febrile infants younger than three months is a significant challenge for clinicians. We aimed to assess the risk factors for SBI in febrile infants. Data were obtained from 221 infants younger than three months who visited a single community referral hospital for fever and underwent a complete sepsis workup between August 2003 and July 2006. The causes of fever were febrile illness without a documented cause (FISDC, 65%), urinary tract infection (UTI, 12%), aseptic meningitis (12%), bacteremia (4%), bacterial meningitis (2%). Cerebrospinal fluid enterovirus polymerase chain reaction was positive in 28% of FISDC and 48% of aseptic meningitis cases. When UTI was excluded, the risk factors for SBI were 1) C-reactive protein (CRP) level of > or =1.87 mg/dL and 2) fevers of > or =38.9 degrees C. The specificity and negative predictive values of risk factors 1) and 2) for the diagnosis of SBI were 94% and 95%, respectively. We concluded that enteroviral infection may be a major cause of febrile episodes in infants younger than three months. If UTI could be excluded, the presence of CRP levels > or =1.87 mg/dL and fevers of > or =38.9 degrees C can be used as criteria to rule out SBI in these infants.
Shin
Seung Han
SH
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
Choi
Chang Won
CW
Lee
Jin-A
JA
Kim
Ee-Kyung
EK
Choi
Eun Hwa
EH
Kim
Han-Suk
HS
Kim
Beyong Il
BI
Choi
Jung-Hwan
JH
D001424:Bacterial Infections / Q000175:diagnosis*; D002097:C-Reactive Protein / Q000032:analysis; D003710:Demography; D004770:Enterovirus / Q000235:genetics / Q000302:isolation & purification; D005260:Female; D005334:Fever / Q000175:diagnosis; D006764:Hospitals, Community; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis; D011237:Predictive Value of Tests; D012307:Risk Factors; D012621:Seasons; D014552:Urinary Tract Infections / Q000175:diagnosis
D002097:C-Reactive Protein