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Observational Study
. 2018 Feb;71(2):211-216.
doi: 10.1016/j.annemergmed.2017.07.488. Epub 2017 Oct 6.

Epidemiology of Bacteremia in Febrile Infants Aged 60 Days and Younger

Elizabeth C Powell  1 , Prashant V Mahajan  2 , Genie Roosevelt  3 , John D Hoyle Jr  4 , Rajender Gattu  5 , Andrea T Cruz  6 , Alexander J Rogers  2 , Shireen M Atabaki  7 , David M Jaffe  8 , T Charles Casper  9 , Octavio Ramilo  10 , Nathan Kuppermann  11 ; Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN)
Collaborators, Affiliations
Observational Study

Epidemiology of Bacteremia in Febrile Infants Aged 60 Days and Younger

Elizabeth C Powell et al. Ann Emerg Med. 2018 Feb.

Abstract

Study objective: To describe the current epidemiology of bacteremia in febrile infants 60 days of age and younger in the Pediatric Emergency Care Applied Research Network (PECARN).

Methods: We conducted a planned secondary analysis of a prospective observational study of febrile infants 60 days of age and younger presenting to any of 26 PECARN emergency departments (2008 to 2013) who had blood cultures obtained. We excluded infants with significant comorbidities or critically ill appearance. The primary outcome was prevalence of bacteremia.

Results: Of 7,335 screened infants, 4,778 (65.1%) had blood cultures and were enrolled. Of these patients, 84 had bacteremia (1.8%; 95% confidence interval [CI] 1.4% to 2.2%). The prevalence of bacteremia in infants aged 28 days or younger (47/1,515) was 3.1% (95% CI 2.3% to 4.1%); in infants aged 29 to 60 days (37/3,246), 1.1% (95% CI 0.8% to 1.6%). Prevalence differed by week of age for infants 28 days of age and younger (0 to 7 days: 4/156, 2.6%; 8 to 14 days: 19/356, 5.3%; 15 to 21 days: 15/449, 3.3%; and 22 to 28 days: 9/554, 1.6%). The most common pathogens were Escherichia coli (39.3%; 95% CI 29.5% to 50.0%) and group B streptococcus (23.8%; 95% CI 16.0% to 33.9%). Bacterial meningitis occurred in 19 of 1,515 infants 28 days of age and younger (1.3%; 95% CI 0.8% to 2.0%) and 5 of 3,246 infants aged 29 to 60 days (0.2%; 95% CI 0.1% to 0.4%). Of 84 infants with bacteremia, 36 (42.9%; 95% CI 32.8% to 53.5%) had urinary tract infections (E coli 83%); 11 (13.1%; 95% CI 7.5% to 21.9%) had bacterial meningitis.

Conclusion: The prevalence of bacteremia and meningitis among febrile infants 28 days of age and younger is high and exceeds that observed in infants aged 29 to 60 days. E coli and group B streptococcus are the most common bacterial pathogens.

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Conflict of interest statement

Conflicts of interest: The authors have no conflicts of interest relevant to this article to disclose.

Figures

Figure 1
Figure 1
Patient enrollment *Indeterminate included cultures with multiple organisms where one could have been a pathogen, or positive gram stain but no bacterial growth
See this image and copyright information in PMC

Comment in

  • Risk Stratifying Febrile Infants: A Moving Target.
    Rouhani A, Claudius I, Behar S, Mason J, Grock A. Rouhani A, et al. Ann Emerg Med. 2018 Feb;71(2):217-219. doi: 10.1016/j.annemergmed.2017.12.009. Epub 2018 Feb 5. Ann Emerg Med. 2018. PMID: 29447862 No abstract available.

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