Changing epidemiology of serious bacterial infections in febrile infants without localizing signs.
OBJECTIVE
Historically, management of infants with fever without localizing signs (FWLS) has generated much controversy, with attempts to risk stratify based on several criteria. Advances in medical practice may have altered the epidemiology of serious bacterial infections (SBIs) in this population. We conducted this study to test the hypothesis that the rate of SBIs in this patient population has changed over time.


METHODS
We performed a retrospective review of all infants meeting FWLS criteria at our institution from 1997-2006. We examined all clinical and outcome data and performed statistical analysis of SBI rates and ampicillin resistance rates.


RESULTS
668 infants met criteria for FWLS. The overall rate of SBIs was 10.8%, with a significant increase from 2002-2006 (52/361, 14.4%) compared to 1997-2001 (20/307, 6.5%) (p = 0.001). This increase was driven by an increase in E. coli urinary tract infections (UTI), particularly in older infants (31-90 days).


CONCLUSIONS
We observed a significant increase in E. coli UTI among FWLS infants with high rates of ampicillin resistance. The reasons are likely to be multifactorial, but the results themselves emphasize the need to examine urine in all febrile infants <90 days and consider local resistance patterns when choosing empiric antibiotics.
Watt
Kevin
K
Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, United States of America.
Waddle
Erica
E
Jhaveri
Ravi
R
D017677:Age Distribution; D000667:Ampicillin / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001424:Bacterial Infections / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male
D000900:Anti-Bacterial Agents; D000667:Ampicillin
Pediatrics. 1994 Sep;94(3):390-6
8065869
JAMA. 1995 Mar 15;273(11):871-5
7869558
Pediatrics. 2006 Aug;118(2):570-6
16882809
J Pediatr. 1982 Nov;101(5):686-9
7131141
Ann Emerg Med. 2000 Dec;36(6):602-14
11097701
Pediatrics. 2002 Oct;110(4):690-5
12359781
Pediatrics. 2005 Sep;116(3):696-702
16140710
J Infect Dis. 2002 Sep 15;186(6):859-64
12198625
Arch Dis Child. 2005 Aug;90(8):853-8
15890696
Pediatrics. 1995 May;95(5):623-7
7724295
J Pediatr. 1979 Nov;95(5 Pt 1):690-5
314972
Pediatrics. 2008 Apr;121(4):689-96
18381532
J Pediatr. 1983 Dec;103(6):864-7
6644419
MMWR Morb Mortal Wkly Rep. 2007 Jul 20;56(28):701-5
17637595
J Clin Microbiol. 2003 May;41(5):1929-35
12734229
J Urol. 1992 Aug;148(2 Pt 2):739-42
1386390
Pediatrics. 2003 May;111(5 Pt 1):964-8
12728072
N Engl J Med. 1973 Jun 21;288(25):1309-12
4145198
Pediatrics. 2005 Sep;116(3):644-8
16140703
N Engl J Med. 1993 Nov 11;329(20):1437-41
8413453
Pediatr Emerg Care. 2001 Apr;17(2):83-7
11334099
JAMA. 2004 Mar 10;291(10):1203-12
15010441
J Pediatr. 1985 Dec;107(6):855-60
4067741
Arch Pediatr Adolesc Med. 2004 Jun;158(6):556-60
15184219
Arch Pediatr Adolesc Med. 1999 Jun;153(6):611-4
10357302
J Pediatr. 1992 Jan;120(1):22-7
1731019
MMWR CDC Surveill Summ. 1992 Nov 20;41(6):25-32
1470102
MMWR Morb Mortal Wkly Rep. 2005 Dec 2;54(47):1205-8
16319814
Pediatr Infect Dis J. 2004 Apr;23(4):295-9
15071281