title: The changing epidemiology of serious bacterial infections in young infants.
abstract: BACKGROUND
  Management of febrile young infants suspected of having serious bacterial infections has been a challenge for decades. The impact of changes in prenatal screening for Group B Streptococcus and of infant immunizations has received little attention in population-based studies.
  
  
  METHODS
  This study analyzed all cultures of blood, urine and cerebrospinal fluid obtained from full-term infants 1 week to 3 months of age, who presented for care at Kaiser Permanente Northern California during a 7-year period utilizing electronic medical records.
  
  
  RESULTS
  A total of 224,553 full-term infants were born during the study period. Of 5396 blood cultures, 129 bacteremic infants were identified (2%). Of 4599 urine cultures, 823 episodes of urinary tract infection (UTI) were documented in 778 infants (17%). Of 1796 CSF cultures, 16 infants had bacterial meningitis (0.9%). The incidence rate of serious bacterial infections (bacteremia, UTI and meningitis) and febrile serious bacterial infections was 3.75 and 3.1/1000 full-term births, respectively. Escherichia coli was the leading cause of bacteremia (78), UTI (719) and bacterial meningitis (7). There were 23 infants with Group B Streptococcus bacteremia including 6 cases of meningitis and no cases of Listeria infection. Nine percentage of infants had multiple sites of infection; 10% of UTIs were associated with bacteremia and 52% of bacteremia was associated with UTI.
  
  
  CONCLUSIONS
  Compared with earlier studies, UTIs now are found significantly more often than bacteremia and meningitis with 92% of occult infections associated with UTIs. These data emphasize the importance of an urinalysis in febrile infants.
authors: From the *Division of Infectious Diseases, Department of Pediatrics, Kaiser Permanente Northern California, San Francisco; †Division of Research, Kaiser Permanente Northern California, Oakland; ‡Division of Infectious Diseases, Department of Pediatrics, Kaiser Permanente Northern California, Hayward; §Department of Pediatrics, Kaiser Permanente Northern California, Oakland; and ¶Department of Pediatrics, Division of General Pediatrics, University of California, San Francisco, CA.
authors: Tara L
authors: TL
authors: Greenhow
authors: Yun-Yi
authors: YY
authors: Hung
authors: Arnd M
authors: AM
authors: Herz
authors: Elizabeth
authors: E
authors: Losada
authors: Robert H
authors: RH
authors: Pantell
mesh_terms: D016470:Bacteremia / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D001424:Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D002140:California / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology