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. 2021 Sep;11(9):e184-e188.
doi: 10.1542/hpeds.2020-002147.

Prevalence of Invasive Bacterial Infections in Well-Appearing, Febrile Infants

Russell J McCulloh  1   2 , Lauren M McDaniel  3 , Ellen Kerns  4   2 , Eric A Biondi  3
Affiliations

Prevalence of Invasive Bacterial Infections in Well-Appearing, Febrile Infants

Russell J McCulloh et al. Hosp Pediatr. 2021 Sep.

Abstract

Background and objectives: Data on invasive bacterial infection (IBI), defined as bacteremia and/or bacterial meningitis, in febrile infants aged <60 days old primarily derive from smaller, dated studies conducted at large, university-affiliated medical centers. Our objective with the current study was to determine current prevalence and epidemiology of IBI from a contemporary, national cohort of well-appearing, febrile infants at university-affiliated and community-based hospitals.

Patients and methods: Retrospective review of well-appearing, febrile infants aged 7 to 60 days was performed across 31 community-based and 44 university-affiliated centers from September 2015 to December 2017. Blood and cerebrospinal fluid bacterial culture results were reviewed and categorized by using a priori criteria for pathogenic organisms. Prevalence estimates and subgroup comparisons were made by using descriptive statistics.

Results: A total of 10 618 febrile infants met inclusion criteria; cerebrospinal fluid and blood cultures were tested from 6747 and 10 581 infants, respectively. Overall, meningitis prevalence was 0.4% (95% confidence interval [CI]: 0.2-0.5); bacteremia prevalence was 2.4% (95% CI: 2.1-2.7). Neonates aged 7 to 30 days had significantly higher prevalence of bacteremia, as compared with infants in the second month of life. IBI prevalence did not differ between community-based and university-affiliated hospitals (2.7% [95% CI: 2.3-3.1] vs 2.1% [95% CI: 1.7-2.6]). Escherichia coli and Streptococcus agalactiae were the most commonly identified organisms.

Conclusions: This contemporary study of well-appearing, febrile infants supports previous epidemiological estimates of IBI prevalence and suggests that the prevalence of IBI may be similar among community-based and university-affiliated hospitals. These results can be used to aid future clinical guidelines and prediction tool development.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr McCulloh, from time to time, provides expert review for legal matters. Dr Biondi provides consultation for McKesson Incorporated and, from time to time, provides expert testimony. The other authors have indicated they have no potential conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Geographic distribution of participating hospitals
See this image and copyright information in PMC

References

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