对因高热（体温达106华氏度或更高）前往急诊科就诊的儿童发生严重细菌感染风险的前瞻性评估。
Prospective evaluation of the risk of serious bacterial infection in children who present to the emergency department with hyperpyrexia (temperature of 106 degrees F or higher).
作者信息
Trautner Barbara W, Caviness A Chantal, Gerlacher Gary R, Demmler Gail, Macias Charles G
机构信息
Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA.
出版信息
Pediatrics. 2006 Jul;118(1):34-40. doi: 10.1542/peds.2005-2823.
BACKGROUND
Previous studies of children with temperatures > or = 106 degrees F (hyperpyrexia) disagree as to whether hyperpyrexia confers a high risk of serious bacterial infection.
OBJECTIVES
The purpose of this study was to determine (1) the risk of serious bacterial infection in children with hyperpyrexia and (2) whether clinical presentation can identify hyperpyrexic patients at risk for serious bacterial infection.
METHODS
Data were collected prospectively on all children <18 years of age presenting to a pediatric emergency department during a 2-year period with rectal temperatures of > or = 106 degrees F. History, physical examination, complete blood cell counts, blood cultures, and nasopharyngeal viral cultures were obtained on all of the patients.
RESULTS
Of 130828 visits, 103 children had hyperpyrexia (1 per 1270 patient visits). Of the 103 subjects, 20 had serious bacterial infection, and 22 had laboratory-proven viral illness (including 1 subject with bacterial/viral coinfection). The presence of a chronic underlying illness was associated with an increased risk of serious bacterial infection. The presence of rhinorrhea or any viral symptom was associated with a decreased risk of serious bacterial infection, although diarrhea itself was associated with an increased risk of serious bacterial infection. Age, maximum temperature, and total white blood cell count were not predictive of either bacterial or viral illness.
CONCLUSIONS
Children with hyperpyrexia are at equally high risk for serious bacterial infection and for viral illness. Bacterial and viral coinfection also occurs. No aspect of the clinical presentation reliably distinguishes between bacterial and viral illness. We recommend consideration of antibiotic treatment for all children presenting to the emergency department with hyperpyrexia without confirmed viral illness.
背景
既往针对体温≥106华氏度（高热）儿童的研究，对于高热是否会带来严重细菌感染的高风险存在分歧。
目的
本研究的目的是确定（1）高热儿童发生严重细菌感染的风险，以及（2）临床表现能否识别有严重细菌感染风险的高热患者。
方法
前瞻性收集了2年间所有年龄＜18岁、直肠温度≥106华氏度且前往儿科急诊科就诊儿童的数据。对所有患者均进行了病史、体格检查、全血细胞计数、血培养及鼻咽部病毒培养。
结果
在130828次就诊中，103名儿童存在高热（每1270次患者就诊中有1例）。在这103名受试者中，20例发生严重细菌感染，22例有实验室确诊的病毒感染（包括1例细菌/病毒混合感染）。存在慢性基础疾病与严重细菌感染风险增加相关。流涕或任何病毒症状的存在与严重细菌感染风险降低相关，尽管腹泻本身与严重细菌感染风险增加相关。年龄、最高体温及白细胞总数均不能预测细菌或病毒感染。
结论
高热儿童发生严重细菌感染和病毒感染的风险同样高。细菌和病毒混合感染也会发生。临床表现的任何方面均不能可靠地区分细菌感染和病毒感染。我们建议，对于所有前往急诊科就诊且无确诊病毒感染的高热儿童考虑使用抗生素治疗。
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