From the Department of Medicine (MW, RB) and the Division of Emergency Medicine (RB), Children's Hospital Boston, Harvard Medical School, Boston, MA.
Acad Emerg Med. 2009 Dec;16(12):1284-1289. doi: 10.1111/j.1553-2712.2009.00582.x.
The objective of this study was to investigate the prevalence of serious bacterial infection (SBI) in febrile infants without a source aged 6-12 weeks who have received immunizations in the preceding 72 hours.
The authors conducted a medical record review of infants aged 6-12 weeks with a fever of > or = 38.0 degrees C presenting to the pediatric emergency department (ED) over 88 months. Infants were classified either as having received immunizations within the 72 hours preceding the ED visit (recent immunization [RI]) or as not having received immunizations during this time period (no recent immunization [NRI]). Primary outcome of an SBI was based on culture results; only patients with a minimum of blood and urine cultures were studied.
A total of 1,978 febrile infants were studied, of whom 213 (10.8%) had received RIs. The overall prevalence of definite SBI was 6.6% (95% confidence interval [CI] = 5.5 to 7.7). The prevalence of definite SBI in NRI infants was 7.0% (95% CI = 5.9 to 8.3) compared to 2.8% (95% CI = 0.6 to 5.1) in the RI infants. The prevalence of definite SBI in febrile infants vaccinated in the preceding 24 hours decreased to 0.6% (95% CI = 0 to 1.9). The prevalence of definite SBI in febrile infants vaccinated greater than 24 hours prior to presentation was 8.9% (95 CI = 1.5 to 16.4). The relative risk of SBI with RI was 0.41 (95% CI = 0.19 to 0.90). All SBIs in the RI infants were urinary tract infections (UTI).
Among febrile infants, the prevalence of SBI is less in the initial 24 hours following immunizations. However, there is still a substantial risk of UTI. Therefore, urine testing should be considered in febrile infants who present within 24 hours of immunization. Infants who present greater than 24 hours after immunizations with fever should be managed similarly to infants without RIs.
本研究旨在调查在接受免疫接种后 72 小时内出现发热（>或=38.0°C）且无感染源的 6-12 周龄婴儿中严重细菌感染（SBI）的发生率。
作者对 88 个月期间因发热（>38.0°C）而就诊于儿科急诊（ED）的 6-12 周龄婴儿进行了病历回顾。婴儿分为免疫接种在 ED 就诊前 72 小时内（近期免疫接种[RI]）或在此期间未接受免疫接种（无近期免疫接种[NRI]）。SBI 的主要结局基于培养结果；仅对接受至少血液和尿液培养的患者进行了研究。
共研究了 1978 例发热婴儿，其中 213 例（10.8%）接受了 RI。明确 SBI 的总体发生率为 6.6%（95%置信区间[CI]为 5.5 至 7.7）。NRI 婴儿中明确 SBI 的发生率为 7.0%（95%CI 为 5.9 至 8.3），而 RI 婴儿中明确 SBI 的发生率为 2.8%（95%CI 为 0.6 至 5.1）。在接种疫苗后 24 小时内发热的婴儿中，明确 SBI 的发生率降至 0.6%（95%CI 为 0 至 1.9）。在就诊前大于 24 小时接种疫苗的发热婴儿中，明确 SBI 的发生率为 8.9%（95%CI 为 1.5 至 16.4）。RI 婴儿的 SBI 相对风险为 0.41（95%CI 为 0.19 至 0.90）。所有 RI 婴儿的 SBI 均为尿路感染（UTI）。
在发热婴儿中，接种疫苗后最初 24 小时内 SBI 的发生率较低。然而，仍存在 UTI 的较大风险。因此，在接种疫苗后 24 小时内就诊的发热婴儿中，应考虑进行尿液检测。在接种疫苗后大于 24 小时发热的婴儿，应与无 RI 的婴儿类似地进行处理。
