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. 2023 Apr;112(4):837-845.
doi: 10.1111/apa.16698. Epub 2023 Feb 15.

A simple clinical decision rule may help to rule out severe bacterial infection and spare antibiotics in febrile young children

Cécile Feildel-Fournial  1 , Lou Danjou  1 , Gaëlle Hubert-Dibon  1 , Bénédicte Vrignaud  1 , Damien Masson  2 , Elise Launay  3   4 , Christèle Gras-Le Guen  1   3
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A simple clinical decision rule may help to rule out severe bacterial infection and spare antibiotics in febrile young children

Cécile Feildel-Fournial et al. Acta Paediatr. 2023 Apr.

Abstract

Aim: To assess the performance of a new clinical decision rule (CDR) to identify patients at a low risk of invasive bacterial infection (IBI) among febrile children and its theoretical impact on antibiotic use.

Methods: Prospective study including consecutive children <5 years of age who presented in one French paediatric emergency department with fever without source between January and December 2016. With the collected data, we constructed a CDR based on a sequential approach based on age, clinical toxic signs, urinalysis and procalcitonin level. We evaluated its diagnostic performances to identify IBI and its potential impact on antibiotic use.

Results: Among the 1061 children (IBI 11/1061, 1.0%), 693 (65.3%) were classified at low or intermediate risk of IBI, with an IBI prevalence of 0%. The sensitivity and specificity of the CDR to predict IBI were 100% and 73.9%. Negative and positive predictive value were 100% and 3.9%, respectively. Using this new CDR, the current antibiotics exposure would theoretically be reduced from 33.6% to 24.1%.

Conclusion: The promising interest of this clinical decision rule, using simple and accessible biological and clinical tools, needs to be confirm with an external validation study, which will allow its use in clinical practice.

Keywords: antibiotic prescriptions; fever without source; occult bacteriemia; procalcitonin = PCT; serious bacterial infection.

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References

REFERENCES

    1. Craig JC, Williams GJ, Jones M, et al. The accuracy of clinical symptoms and signs for the diagnosis of serious bacterial infection in young febrile children: prospective cohort study of 15 781 febrile illnesses. BMJ. 2010;340:c1594.
    1. Hubert-Dibon G, Danjou L, Feildel-Fournial C, et al. Procalcitonin and C-reactive protein may help to detect invasive bacterial infections in children who have fever without source. Acta Paediatr. 1992;2018(107):1262-1269.
    1. Andreola B, Bressan S, Callegaro S, Liverani A, Plebani M, Da Dalt L. Procalcitonin and C-reactive protein as diagnostic markers of severe bacterial infections in febrile infants and children in the emergency department. Pediatr Infect Dis J. 2007;26:672-677.
    1. Hewitt IK, Zucchetta P, Rigon L, et al. Early treatment of acute pyelonephritis in children fails to reduce renal scarring: data from the Italian renal infection study trials. Pediatrics. 2008;122:486-490.
    1. Launay E, Gras-Le Guen C, Martinot A, et al. Why children with severe bacterial infection die: a population-based study of determinants and consequences of suboptimal care with a special emphasis on methodological issues. PloS One. 2014;9:e107286.

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