University of Wisconsin-Madison, Department of Pediatrics, 600 Highland Ave, Madison, WI 53792, USA.
Pediatrics. 2010 Feb;125(2):228-33. doi: 10.1542/peds.2009-1070. Epub 2010 Jan 18.
The goal was to determine the performance of low-risk criteria for serious bacterial illnesses (SBIs) in febrile infants in prospective studies in which empiric antibiotic treatment was withheld, compared with studies (prospective and retrospective) in which empiric antibiotic treatment was administered.
A search of the English-language literature was undertaken by using a PubMed database and reference lists of relevant studies of fever, low-risk criteria, and SBIs. Studies of infants >90 days of age, infants with specific infections, or infants with additional risk factors for infection were excluded. Publications were categorized as retrospective, prospective with empiric antibiotic treatment for all patients, or prospective with antibiotics withheld. The relative risk of SBI in high-risk versus low-risk patients was determined for pooled data in each category. The rates of SBIs in low-risk patients in each category were compared.
Twenty-one studies met the inclusion criteria. In prospective studies in which patients were cared for without empiric antibiotic treatment, 6 patients assigned to the low-risk category had SBIs; all recovered uneventfully. The rate of SBIs in these low-risk patients was 0.67%. The relative risk of SBIs in high-risk versus low-risk patients in these studies was 30.56 (95% confidence interval: 7.0-68.13). The rate of SBIs in low-risk patients in all studies was 2.23%. The rate of SBIs in low-risk patients in the prospective studies without empiric antibiotic treatment was significantly different from the rate in all other studies (0.67% vs 2.71%; P = .01).
Low-risk criteria perform well in prospective studies in which empiric antibiotic treatment is withheld. These criteria allow approximately 30% of young febrile infants to be observed without antibiotic treatment, thus avoiding unnecessary hospitalization, nosocomial infection, injudicious use of antibiotics, and adverse effects of antibiotics.
本研究旨在确定在未使用经验性抗生素治疗的前瞻性研究中，针对严重细菌感染（SBI）的低危标准的表现，与使用经验性抗生素治疗的前瞻性和回顾性研究进行比较。
通过使用 PubMed 数据库和发热、低危标准和 SBI 的相关研究的参考文献列表，对英文文献进行了检索。排除了年龄>90 天的婴儿、有特定感染的婴儿或有其他感染危险因素的婴儿的研究。根据研究类型（回顾性、所有患者均使用经验性抗生素治疗的前瞻性或不使用抗生素的前瞻性）对出版物进行分类。在每个类别中，确定了高危与低危患者的 SBI 相对风险。比较了每个类别中低危患者的 SBI 发生率。
符合纳入标准的研究有 21 项。在未使用经验性抗生素治疗的前瞻性研究中，6 名低危患者发生了 SBI；所有患者均顺利康复。这些低危患者的 SBI 发生率为 0.67%。在这些研究中，高危与低危患者的 SBI 相对风险为 30.56（95%置信区间：7.0-68.13）。所有研究中低危患者的 SBI 发生率为 2.23%。未使用经验性抗生素治疗的前瞻性研究中低危患者的 SBI 发生率与其他所有研究显著不同（0.67%比 2.71%；P=0.01）。
在未使用经验性抗生素治疗的前瞻性研究中，低危标准表现良好。这些标准允许约 30%的年轻发热婴儿无需抗生素治疗即可接受观察，从而避免了不必要的住院、医院感染、抗生素不合理使用和抗生素的不良反应。
