Journal of the Chinese Medical Association
Volume 72, Issue 10 , Pages 521-526, October 2009

A Model for Predicting Risk of Serious Bacterial Infection in Febrile Infants Younger Than 3 Months of Age

  • Chun-Jen Chen

      Affiliations

    • Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Chun-Jen Chen and Yu-Fang Lo contributed equally to this work.
    • ,
  • Yu-Fang Lo

      Affiliations

    • Department of Pediatrics, Cheng Hsin Rehabilitation Medical Center, Taipei, Taiwan, R.O.C.
    • Chun-Jen Chen and Yu-Fang Lo contributed equally to this work.
    • ,
  • Miao-Chiu Huang

      Affiliations

    • Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Ruey-Lung Chung

      Affiliations

    • Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Ren-Bin Tang

      Affiliations

    • Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Keh-Gong Wu

      Affiliations

    • Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Keh-Gong Wu, Department of Pediatrics, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C.

Received 20 May 2009; accepted 23 September 2009.

Article Outline

Background

The objective of this study was to construct a model for predicting the risk of serious bacterial infection (SBI) in febrile infants.

Methods

A total of 135 febrile infants younger than 3 months of age who met the inclusion criteria were assessed on the following: physical appearance, complete blood count, serum C-reactive protein (CRP), urinalysis, stool smears for white blood cell (WBC) count if diarrhea was apparent, and blood and urine cultures. Chest X-rays were performed if respiratory symptoms were evident. Cerebrospinal fluid was analyzed if central nervous system infection was suspected.

Results

Of the 135 infants, 34 were diagnosed with SBI. Data from 99 infants were used to construct a model for predicting SBI by multivariate logistic regression. Sex (male), spun urine WBC count (≥ 10 per high-powered field [400 ×]) and CRP (≥ 3.6 mg/L) were significantly related to SBI. A probability cut-off of 0.265 was selected, where values below and above the cut-off reflected low and high SBI risk respectively. Data from the remaining 36 infants were used to test model validity. Both sensitivity and specificity were 77.8% for predicting SBI using this model.

Conclusion

These findings suggest that sex, serum CRP concentration and spun urine WBC count can be used to accurately predict SBI in febrile infants aged less than 3 months of age. [J Chin Med Assoc 2009;72(10):521–526]

Key Words:  C-reactive protein , febrile infants , neonatal sepsis , risk factors , serious bacterial infection

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. McCarthy PL . Infants with fever . N Engl J Med . 1993;329:1493–1494
  2. Baskin MN , O'Rourke EJ , Fleisher GR . Outpatient treatment of febrile infants 28 to 89 days of age with intramuscular administration of ceftriaxone . J Pediatr . 1992;120:22–27
  3. Dagan R , Powell KR , Hall CB , Menegus MA . Identification of infants unlikely to have serious bacterial infection although hospitalized for suspected sepsis . J Pediatr . 1985;107:855–860
  4. Chiu CH , Lin TY . Fever in infants less than 3 months of age . Acta Paediatr Taiwan . 1994;35:273–279
  5. Chiu CH , Lin TY , Bullard MJ . Identification of febrile neonates unlikely to have bacterial infections . Pediatr Infect Dis J . 1997;16:59–63
  6. Bachur RG , Harper MB . Predictive model for serious bacterial infections among infants younger than 3 months of age . Pediatrics . 2001;108:311–316
  7. Ayoola OO , Adeyemo AA , Osinusi K . Predictors of bacteraemia among febrile infants in Ibadan, Nigeria . J Health Popul Nutr . 2002;20:223–229
  8. Bonsu BK , Chb M , Harper MB . Identifying febrile young infants with bacteremia: is the peripheral white blood cell count an accurate screen? . Ann Emerg Med . 2003;42:216–225
  9. Baraff LJ , Oslund SA , Schriger DL , Stephen ML . Probability of bacterial infections in febrile infants less than three months of age: a meta-analysis . Pediatr Infect Dis J . 1992;11:257–264
  10. Pulliam PN , Attia MW , Cronan KM . C-reactive protein in febrile children 1 to 36 months of age with clinically undetectable serious bacterial infection . Pediatrics . 2001;108:1275–1279
  11. Marom R, Sakran W, Antonelli J, Horovitz Y, Zarfin Y, Koren A, et al. Quick identification of febrile neonates with low risk for serious bacterial infection: an observational study . Arch Dis Child Fetal Neonatal Ed . 2007;92:F15–F18
  12. Hsiao AL , Baker MD . Fever in the new millennium: a review of recent studies of markers of serious bacterial infection in febrile children . Curr Opin Pediatr . 2005;17:56–61
  13. Baker MD , Bell LM , Avner JR . Outpatient management without antibiotics of fever in selected infants . N Engl J Med . 1993;329:1437–1441
  14. Baker MD , Bell LM . Unpredictability of serious bacterial illness in febrile infants from birth to 1 month of age . Arch Pediatr Adolesc Med . 1999;153:508–511
  15. Galetto-Lacour A , Zamora SA , Gervaix A . Bedside procalcitonin and C-reactive protein tests in children with fever without localizing signs of infection seen in a referral center . Pediatrics . 2003;112:1054–1060
  16. Berger RM , Berger MY , van Steensel-Moll HA , Dzoljic-Danilovic G , Derksen-Lubsen G . A predictive model to estimate the risk of serious bacterial infections in febrile infants . Eur J Pediatr . 1996;155:468–473
  17. Isaacman DJ , Shults J , Gross TK , Davis PH , Harper M . Predictors of bacteremia in febrile children 3 to 36 months of age . Pediatrics . 2000;106:977–982
  18. Garra G , Cunningham SJ , Crain EF . Reappraisal of criteria used to predict serious bacterial illness in febrile infants less than 8 weeks of age . Acad Emerg Med . 2005;12:921–925
  19. Gendrel D, Raymond J, Coste J, Moulin F, Lorrot M, Guérin S, et al  Comparison of procalcitonin with C-reactive protein, interleukin 6 and interferon-alpha for differentiation of bacterial vs. viral infections . Pediatr Infect Dis J . 1999;18:875–881
  20. Wasserman GM , White CB . Evaluation of the necessity for hospitalization of the febrile infant less than three months of age . Pediatr Infect Dis J . 1990;9:163–169

PII: S1726-4901(09)70421-6

doi:10.1016/S1726-4901(09)70421-6

Journal of the Chinese Medical Association
Volume 72, Issue 10 , Pages 521-526, October 2009

Article Tools