Skip to main content

Advertisement

SpringerLink
Log in

Identifying Serious Bacterial Infections in Febrile Young Infants

  • Perspective
  • Published:
Indian Pediatrics Aims and scope Submit manuscript

Abstract

Fever is one of the most common presenting complaints among infants brought to pediatric emergency. Although most of the infants have benign, self-limiting viral infections, approximately 10% of all may have serious bacterial infection. Clinical examination alone is insufficient to detect serious bacterial infection in well appearing infants, and a standardized approach is always sought for. However, guidelines used in the United States or European countries may not be applicable in a tropical country like India. Deviation from these guidelines leads to challenges of unwarranted hospitalization and antibiotic usage, extra cost of care and risk of antimicrobial resistance. Various prediction rules can detect a low risk infant with negative predictive values ranging from 93.7–100%. While use of biomarkers such as C reactive protein and procalcitonin can be reliable, it is costly and may not be applicable to the local population. Validation studies over varied population are needed in future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Balmuth F, Henretig FM, Alpern ER. Fever. In: RG Bachur and KN Shaw (eds.) Fleisher & Ludwig’s Textbook of Pediatric Emergency Medicine, 7th edition. Lippincott Williams and Wilkins. 2016. p. 176–85.

  2. Mace SE, Gemme SR, Valente JH, et al. Clinical policy for well-appearing infants and children younger than 2 years of age presenting to the emergency department with fever. Ann Emerg Med. 2016;67:625–39.

    Article  Google Scholar 

  3. Biondi EA, Byington CL. Evaluation and management of febrile, well appearing young infants. Infect Dis Clin North Am. 2015;29:575–85.

    Article  Google Scholar 

  4. Furyk JS, Swann O, Molyneux E. Systematic review: Neonatal meningitis in the developing world. Trop Med Int Health. 2011;16:672–79.

    Article  CAS  Google Scholar 

  5. BaraffL J, Bass JW, Fleisher GR, et al. Practice guideline for the management of infants and children 0 to 36 months of age with fever without source. Agency for Healthcare Policy and Research. Ann Emergency Med. 1993;22:1198–210.

    Article  Google Scholar 

  6. For Academic College of Emergency Experts in India (ACEE-INDIA) — INDO US Emergency and Trauma Collaborative, Mahajan P, Batra P, Thakur N, et al. Consensus Guidelines on Evaluation and Management of the Febrile Child Presenting to the Emergency Department in India. Indian Pediatr. 2017;54:652–60.

    Article  Google Scholar 

  7. Kozel TR, Burnham-Marusich AR. Point-of-Care testing for infectious diseases: Past, present, and future. J Clin Microbiol. 2017;55:2313–20.

    Article  CAS  Google Scholar 

  8. Meehan WP, Fleegler E, Bachur RG. Adherence to guidelines for managing the well-appearing febrile infant: Assessment using a case-based, interactive survey. Pediatr Emerg Care. 2010;26:875–80.

    Article  Google Scholar 

  9. 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;120:22–7.

    Article  CAS  Google Scholar 

  10. Baker MD, Bell LM, Avner JR. Outpatient management without antibiotics of fever in selected infants. N Engl J Med. 1993;329:1437–41.

    Article  CAS  Google Scholar 

  11. Powell KR. Evaluation and management of febrile infants younger than 60 days of age. Pediatr Infect Dis J. 1990;9:153–7.

    Article  CAS  Google Scholar 

  12. Rogers AJ, Kuppermann N, Anders J, et al. Practice variation in the evaluation and disposition of febrile infants ≥ 60 days of age. J Emerg Med. 2019;56:583–91.

    Article  Google Scholar 

  13. Powell EC, Mahajan PV, Roosevelt G, et al. Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN). Epidemiology of bactere-mia in febrile infants aged 60 days and younger. Ann Emerg Med. 2018;71:211–6.

    Article  Google Scholar 

  14. Scarfone R, Murray A, Gala P, Balamuth F. Lumbar puncture for all febrile infants 29–56 days old: A retrospective cohort reassessment study. J Pediatr. 2017;187:200–5.

    Article  Google Scholar 

  15. Chua KP, Neuman MI, McWilliams JM, Aronson PL. Febrile Young Infant Research Collaborative. Association between clinical outcomes and hospital guidelines for cerebrospinal fluid testing in febrile infants aged 29–56 days. J Pediatr. 2015;167:1340–46.

    Article  Google Scholar 

  16. Wallace SS, Brown DN, Cruz AT. Prevalence of concomitant acute bacterial meningitis in neonates with febrile urinary tract infection: A retrospective cross-sectional study. J Pediatr. 2017;184:199–203.

    Article  Google Scholar 

  17. Poletto E, Zanetto L, Velasco R, Da Dalt L, Bressan S. Bacterial meningitis in febrile young infants acutely assessed for presumed urinary tract infection: A systematic review. Eur J Pediatr. 2019;178:1577–87.

    Article  Google Scholar 

  18. Aronson PL, Thurm C, Williams DJ, et al. Febrile Young Infant Research Collaborative. Association of clinical practice guidelines with emergency department management of febrile infants >56 days of age. J Hosp Med. 2015;10:358–65.

    Article  Google Scholar 

  19. Aronson PL, Thurm C, Alpern ER, et al., Febrile Young Infant Research Collaborative. Variation in care of the febrile young infant <90 days in US pediatric emergency departments. Pediatrics. 2014;134:666–67.

    Article  Google Scholar 

  20. Aronson PL, Wang ME, Shapiro ED, et al. Risk stratification of febrile infants ≥ 60 days old without routine lumbar puncture. Pediatrics. 2018;142:e20181879.

    Article  Google Scholar 

  21. McCarthy PL, Sharpe MR, Spiesel SZ, et al. Observation scales to identify serious illness in febrile children. Pediatrics. 1982;70:802–9.

    CAS  PubMed  Google Scholar 

  22. Nigrovic LE, Mahajan PV, Blumberg SM, et al. The Yale Observation Scale score and the risk of serious bacterial infections in febrile infants. Pediatrics. 2017;140:e20170695.

    Article  Google Scholar 

  23. Lyons TW, Garro AC, Cruz AT, et al. Performance of the modified Boston and Philadelphia criteria for invasive bacterial infections. Pediatrics. 2020;145:e20193538.

    Article  Google Scholar 

  24. Kuppermann N, Dayan PS, Levine DA, et al. A clinical prediction rule to identify febrile infants 60 days and younger at low risk for serious bacterial infections. JAMA Pediatr. 2019;173:342–51.

    Article  Google Scholar 

  25. 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;108:1275–9.

    Article  CAS  Google Scholar 

  26. Grendel D, Raymond J, Coste J, et al. Comparison of procalcitonin with C-reactive protein, interleukin-6 and interferon-alpha for differentiation of bacterial versus viral infections. Pediatr Infect Dis J. 1999;18:875–81.

    Article  Google Scholar 

  27. Grendel D, Bohuon C. Procalcitonin as a marker of bacterial infection. Pediatr Infect Dis J. 2000;19:679–88.

    Article  Google Scholar 

  28. Jaye DL, Waites KB. Clinical applications of C-reactive protein in pediatrics. Pediatr Infect Dis J. 1997;16:735–46.

    Article  CAS  Google Scholar 

  29. Dandona P, Nix D, Wilson MF, et al. Procalcitonin increase after endotoxin injection in normal subjects. J Clin Endocrinol Metab. 1994;79:1605–8.

    CAS  PubMed  Google Scholar 

  30. Van Rossum AMC, Wulkan RW, Oudesluys-Murphy AM. Procalcitonin as an early marker of infection in neonates and children. Lancet Infect Dis. 2004;4:620–30.

    Article  CAS  Google Scholar 

  31. Olaciregui I, Hernandez U, Muñoz JA, Emparanza JI, Landa JJ. Markers that predict serious bacterial infection in infants under 3 months of age presenting with fever of unknown origin. Arch Dis Child. 2009;94:501–5.

    Article  CAS  Google Scholar 

  32. Mintegi S, Bressan S, Gomez B, et al. Accuracy of a sequential approach to identify young febrile infants at low risk for invasive bacterial infection. Emerg Med J. 2014;31:e19–24.

    Article  Google Scholar 

  33. Gomez B, Mintegi S, Bressan S, Da Dalt L, Gervaix A, Lacroix L. Validation of the “step-by-step” approach in the management of young febrile infants. Pediatrics. 2016;138:e20154381.

    Article  Google Scholar 

  34. Galetto-Lacour A, Zamora SA, Andreola B, et al. Validation of a laboratory risk index score for the identification of severe bacterial infection in children with fever without source. Arch Dis Child. 2010;95:968–73.

    Article  Google Scholar 

  35. Mahajan P, Kuppermann N, Mejias A, et al. Association of RNA biosignatures with bacterial infections in febrile infants aged 60 days or younger. JAMA. 2016;316:846–57.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, 110 095, India

    Vikram Bhaskar & Prerna Batra

  2. Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA

    Prashant Mahajan

Authors
  1. Vikram Bhaskar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Prerna Batra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Prashant Mahajan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Prerna Batra.

Additional information

Contributors

PB, PM: conceived the idea; VB, PB: drafted the manuscript; PM: reviewed it critically. All authors approved the final version of manuscript, and are accountable for all aspects related to the study.

Funding

None

Competing interest

None stated.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bhaskar, V., Batra, P. & Mahajan, P. Identifying Serious Bacterial Infections in Febrile Young Infants. Indian Pediatr 58, 15–19 (2021). https://doi.org/10.1007/s13312-021-2089-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13312-021-2089-6

Keywords

Search

Navigation