title: Characteristics of children with microbiologically confirmed invasive bacterial infections in the emergency department.
abstract: BACKGROUND
  Determination of the characteristics of paediatric invasive bacterial infections (IBI) is essential for early identification of children requiring immediate antibiotic therapy. The main objective is to characterize the emergency presentation of the IBI among children aged younger than 14 years.
  
  
  METHODS
  A prospective registry-based cohort study including all patients aged younger than 14 years diagnosed with confirmed IBI (culture or genomic detection using the polymerase chain reaction) was carried out in a paediatric emergency department between 2008 and 2015. Severity criteria were as follows: death, sequelae or admission to the ICU.
  
  
  RESULTS
  Of the 223 IBIs reported, 187 (83.9%) corresponded to previously healthy patients (median age=19 months) and 165 (74%) were well appearing. The most common diagnoses were occult bacteraemia [60 (26.9%)] and sepsis [56 (25.1%)]. The most frequent pathogens were Streptococcus pneumoniae [68 (30.5%)] and Neisseria meningitidis [42 (18.8%)]. Four (1.8) patients died (S. pneumoniae, 2) and eight (3.5%) had sequelae (S. pneumoniae, 5). The diagnoses and clinical characteristics of the children varied significantly depending on the isolated pathogen. Duration of fever less than 24 h, symptoms other than fever and not being well-appearing upon arrival to the emergency department were independent risk factors for greater severity (area under the receiver operating characteristics curve=0.805; 95% confidence interval: 0.741-0.868).
  
  
  CONCLUSIONS
  IBIs are commonly diagnosed in previously healthy and well-appearing young children. S. pneumoniae was responsible for the majority of deaths or sequelae. Short duration of fever, symptoms other than fever and not being stable on arrival are associated with greater severity.
authors.affiliation: Paediatric Emergency Department, Cruces University Hospital.
authors.forename: Iker
authors.initials: I
authors.lastname: Gangoiti
authors.affiliation: Paediatric Emergency Department, Cruces University Hospital.
authors.forename: Juan R
authors.initials: JR
authors.lastname: Valle
authors.affiliation: Department of Microbiology, Cruces University Hospital, BioCruces Health Research Institute, University of the Basque Country.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Sota
authors.affiliation: Epidemiology Unit, Cruces University Hospital, BioCruces Health Research Institute, Bilbao, Basque Country, Spain.
authors.forename: Lorea
authors.initials: L
authors.lastname: Martinez-Indart
authors.affiliation: Paediatric Emergency Department, Cruces University Hospital.
authors.forename: Javier
authors.initials: J
authors.lastname: Benito
authors.affiliation: Paediatric Emergency Department, Cruces University Hospital.
authors.forename: Santiago
authors.initials: S
authors.lastname: Mintegi
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006776:Hospitals, Pediatric; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009345:Neisseria meningitidis / Q000302:isolation & purification; D011446:Prospective Studies; D012372:ROC Curve; D012042:Registries; D018570:Risk Assessment; D013030:Spain; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents