Pediatric Hospitalists of South Florida, Joe Dimaggio Children's Hospital, Hollywood, Florida, USA.
J Hosp Med. 2010 Feb;5(2):76-82. doi: 10.1002/jhm.583.
Well-appearing young infants with focal bacterial infections present to the emergency department (ED) and are often admitted for a sepsis evaluation of blood, urine, and spinal fluid. However, the risk of concomitant systemic infections (CSI) in this population is not well reported, specifically comparing febrile to afebrile infants. We hypothesized that afebrile, well-appearing infants under two months of age with a defined focal bacterial infection on exam have a very low risk of CSI.
This retrospective study was conducted at an urban, academic, tertiary care pediatric hospital ED on patients seen from January 2000-December 2005. Eligible infants were less than 60 days of age, well-appearing on exam, and with normal-for-age vital signs who presented with a focal bacterial infection on exam. Exclusion criteria included immunodeficiency, indwelling catheter, previous admission for bacterial infection, or current use of systemic antibiotics. Main study outcome was risk of CSI in febrile and afebrile groups.
One hundred ninety seven patients were included in the study population. Of these, 39 were febrile and 158 were afebrile. Four patients had a documented CSI: one case of S. pneumoniae bacteremia and three cases of E. coli urinary tract infection. Of these 4 infants, 3 were febrile (7.7% CSI risk) and 1 was afebrile (0.6%). Febrile infants had a significantly higher risk of CSI (OR 13.1, 95% CI 1.3, 129.5).
CSI is very uncommon in afebrile, well-appearing infants under 60 days of age with a focal bacterial infection.
表现良好的年轻婴儿出现局灶性细菌感染时会到急诊科就诊，通常需要进行血液、尿液和脑脊液的败血症评估。然而，该人群中同时存在全身感染（CSI）的风险并未得到很好的报道，特别是在比较发热和不发热的婴儿时。我们假设在检查中表现为不发热、外观良好且有明确局灶性细菌感染的两个月以下婴儿发生 CSI 的风险非常低。
这项回顾性研究在一家城市、学术性、三级保健儿科医院急诊科进行，研究对象为 2000 年 1 月至 2005 年 12 月就诊的患者。符合条件的婴儿年龄小于 60 天，检查时外观良好，且生命体征与年龄相符，有明确的局灶性细菌感染。排除标准包括免疫缺陷、留置导管、以前因细菌感染入院或当前使用全身抗生素。主要研究结局为发热组和不发热组 CSI 的风险。
本研究共纳入 197 例患者。其中 39 例发热，158 例不发热。有 4 例患者发生了 CSI，其中包括 1 例肺炎链球菌菌血症和 3 例大肠埃希菌尿路感染。这 4 例婴儿中，3 例发热（7.7%的 CSI 风险），1 例不发热（0.6%）。发热婴儿发生 CSI 的风险显著更高（OR 13.1，95%CI 1.3，129.5）。
在 60 天以下且有局灶性细菌感染的不发热、外观良好的婴儿中，CSI 非常罕见。
