Hernández-Bou Susanna, Trenchs Victoria, Alarcón Marcela, Luaces Carles
From the Paediatric Emergency Department, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain.
Pediatr Infect Dis J. 2014 Mar;33(3):244-7. doi: 10.1097/INF.0000000000000033.
Some authors have assessed the utility of considering various risk factors in predicting bacteremia in young infants with urinary tract infection (UTI) in studies that included only febrile patients. Our aims were to determine whether fever was a predictor for bacteremia and to identify other associated risk factors.
A retrospective study was conducted that included infants 29 to 90 days of age with UTI attended in the Pediatric Emergency Department from September 2006 through May 2013. UTI was defined as growth of ≥ 50,000 colony forming units/mL of a single pathogen from a catheterized specimen in association with an abnormal urinalysis. Patients without a blood culture were excluded. Univariate testing was used to identify clinical and laboratory factors associated with bacteremia. Receiver operating characteristic curves were constructed for the laboratory markers associated with bacteremia.
We analyzed 350 patients; 77 (22%) were afebrile. Ten had bacteremia (2.9%, 95% confidence interval: 1.6%-5.2%). No other adverse events were identified. No differences were found in bacteremia rates between febrile and afebrile patients (2.9% vs. 2.6%; P = 1.0). Risk factors detected for bacteremia were classified as not well-appearing (25.0% vs. 2.1%; P = 0.003) and a procalcitonin value ≥ 0.7 ng/mL (6.4% vs. 0.5%; P = 0.001). These low-risk criteria yielded a sensitivity of 88.9% for detecting bacteremia with a negative predictive value of 99.5%.
Afebrile young infants with UTI should not be classified a priori as low risk for bacteremia. Well-appearing young infants with UTI and procalcitonin value <0.7 ng/mL were at very low risk for bacteremia; outpatient management with an appropriate follow-up could be considered.
在仅纳入发热患者的研究中，一些作者评估了考虑多种风险因素对预测尿路感染（UTI）的小婴儿菌血症的作用。我们的目的是确定发热是否为菌血症的预测因素，并识别其他相关风险因素。
进行了一项回顾性研究，纳入了2006年9月至2013年5月在儿科急诊科就诊的29至90日龄UTI婴儿。UTI定义为导尿标本中单一病原体的菌落形成单位/mL≥50,000，且伴有异常尿液分析。排除未进行血培养的患者。采用单因素检验来识别与菌血症相关的临床和实验室因素。为与菌血症相关的实验室指标构建了受试者工作特征曲线。
我们分析了350例患者；77例（22%）无发热。10例有菌血症（2.9%，95%置信区间：1.6%-5.2%）。未发现其他不良事件。发热和无发热患者的菌血症发生率无差异（2.9%对2.6%；P = 1.0）。检测到的菌血症风险因素分为外观不佳（25.0%对2.1%；P = 0.003）和降钙素原值≥0.7 ng/mL（6.4%对0.5%；P = 0.001）。这些低风险标准检测菌血症的敏感性为88.9%，阴性预测值为99.5%。
UTI的无发热小婴儿不应先验地归类为菌血症低风险。UTI且外观良好、降钙素原值<0.7 ng/mL的小婴儿菌血症风险非常低；可考虑进行适当随访的门诊管理。
