Cargando…

Fever in Infants: Assessing Variability in Sepsis Evaluation

BACKGROUND: Fever is a common presentation of infants resulting in frequent medical visits. Since fever may be the sole sign of invasive bacterial infection (IBI) in infants less than 3 months of age, invasive testing is often performed. Many physicians are guided by standardized criteria, which wer...

Descripción completa

Detalles Bibliográficos
Autores principales: Schmit, Kathryn, Conway, James, Allen, Ann
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5630908/
http://dx.doi.org/10.1093/ofid/ofx163.1842
_version_ 1783269322177642496
author Schmit, Kathryn
Conway, James
Allen, Ann
author_facet Schmit, Kathryn
Conway, James
Allen, Ann
author_sort Schmit, Kathryn
collection PubMed
description BACKGROUND: Fever is a common presentation of infants resulting in frequent medical visits. Since fever may be the sole sign of invasive bacterial infection (IBI) in infants less than 3 months of age, invasive testing is often performed. Many physicians are guided by standardized criteria, which were created to aid in determining those at low risk of IBI. Though these criteria exist, there is limited guidance regarding appropriate testing in the first month of life and wide variability in practice during the first 90 days. An American Academy of Pediatrics national quality improvement collaboration, Reducing Excessive Variability in Infant Sepsis Evaluation, is standardizing management of these infants. This study evaluates current institutional practice in assessing febrile infants. METHODS: Retrospective chart review of well-appearing previously healthy term infants with no obvious source of fever on initial examination between the ages of 0–90 days presenting with documented or reported fever to either a tertiary emergency department or inpatient hospital, with specific International Classification of Diseases codes over 1 year period. The infants were then separated into three groups: 0–28, 29–60 and 61–90 days. RESULTS: Of 83 infants meeting criteria, 10% had IBI with 75% of these being urinary tract infection. Evaluation with complete blood count (CBC), blood culture, urinalysis (UA) and urine culture varied between groups from 84%, 87% and 29% respectively. Within this latter group, 75% were underimmunized. CBC results were abnormal in 64% of all infants with leukopenia the most common abnormality. Of those with bacterial infection and where CBC was obtained, 50% had leukopenia and 50% had normal white blood cell (WBC) count. UA collection differed between the groups from 88%, 87% and 68% and lumbar puncture attempts performed in 84%, 30% and 4%. CXR was obtained in 27% of infants and all were negative; 40% of these infants that underwent imaging were asymptomatic. CONCLUSION: Most criteria rely on leukocytosis to identify high risk for IBI; infants with IBI in this study had leukopenia or normal WBC counts. Sepsis evaluation in febrile infants varies tremendously and an updated guideline for identifying IBI could minimize unnecessary imaging, laboratory testing and unwarranted antibiotic therapy. DISCLOSURES: All authors: No reported disclosures.
format Online
Article
Text
id pubmed-5630908
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-56309082017-11-07 Fever in Infants: Assessing Variability in Sepsis Evaluation Schmit, Kathryn Conway, James Allen, Ann Open Forum Infect Dis Abstracts BACKGROUND: Fever is a common presentation of infants resulting in frequent medical visits. Since fever may be the sole sign of invasive bacterial infection (IBI) in infants less than 3 months of age, invasive testing is often performed. Many physicians are guided by standardized criteria, which were created to aid in determining those at low risk of IBI. Though these criteria exist, there is limited guidance regarding appropriate testing in the first month of life and wide variability in practice during the first 90 days. An American Academy of Pediatrics national quality improvement collaboration, Reducing Excessive Variability in Infant Sepsis Evaluation, is standardizing management of these infants. This study evaluates current institutional practice in assessing febrile infants. METHODS: Retrospective chart review of well-appearing previously healthy term infants with no obvious source of fever on initial examination between the ages of 0–90 days presenting with documented or reported fever to either a tertiary emergency department or inpatient hospital, with specific International Classification of Diseases codes over 1 year period. The infants were then separated into three groups: 0–28, 29–60 and 61–90 days. RESULTS: Of 83 infants meeting criteria, 10% had IBI with 75% of these being urinary tract infection. Evaluation with complete blood count (CBC), blood culture, urinalysis (UA) and urine culture varied between groups from 84%, 87% and 29% respectively. Within this latter group, 75% were underimmunized. CBC results were abnormal in 64% of all infants with leukopenia the most common abnormality. Of those with bacterial infection and where CBC was obtained, 50% had leukopenia and 50% had normal white blood cell (WBC) count. UA collection differed between the groups from 88%, 87% and 68% and lumbar puncture attempts performed in 84%, 30% and 4%. CXR was obtained in 27% of infants and all were negative; 40% of these infants that underwent imaging were asymptomatic. CONCLUSION: Most criteria rely on leukocytosis to identify high risk for IBI; infants with IBI in this study had leukopenia or normal WBC counts. Sepsis evaluation in febrile infants varies tremendously and an updated guideline for identifying IBI could minimize unnecessary imaging, laboratory testing and unwarranted antibiotic therapy. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2017-10-04 /pmc/articles/PMC5630908/ http://dx.doi.org/10.1093/ofid/ofx163.1842 Text en © The Author 2017. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Schmit, Kathryn
Conway, James
Allen, Ann
Fever in Infants: Assessing Variability in Sepsis Evaluation
title Fever in Infants: Assessing Variability in Sepsis Evaluation
title_full Fever in Infants: Assessing Variability in Sepsis Evaluation
title_fullStr Fever in Infants: Assessing Variability in Sepsis Evaluation
title_full_unstemmed Fever in Infants: Assessing Variability in Sepsis Evaluation
title_short Fever in Infants: Assessing Variability in Sepsis Evaluation
title_sort fever in infants: assessing variability in sepsis evaluation
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5630908/
http://dx.doi.org/10.1093/ofid/ofx163.1842
work_keys_str_mv AT schmitkathryn feverininfantsassessingvariabilityinsepsisevaluation
AT conwayjames feverininfantsassessingvariabilityinsepsisevaluation
AT allenann feverininfantsassessingvariabilityinsepsisevaluation