Miller Aaron S, Hall Laura E, Jones Katherine M, Le Catherine, El Feghaly Rana E
From the *Divisions of Hospitalist Medicine and Infectious Diseases, Department of Pediatrics, St. Louis University, St. Louis, MO; †Division of Hospitalist Medicine, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO; ‡Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN; and §Division of Infectious Diseases, Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS.
Pediatr Emerg Care. 2017 Aug;33(8):e15-e20. doi: 10.1097/PEC.0000000000000532.
Afebrile infants 0 to 60 days of age are sometimes evaluated for serious bacterial infection (SBI). Our objective was to describe the clinical and laboratory findings in this population and compare them to their febrile counterparts.
We performed a retrospective observational study comparing afebrile infants undergoing an SBI evaluation to those evaluated for fever.
We included infants who were admitted to the hospital and had at least 2 of 3 following bacterial cultures: blood, urine, or cerebrospinal fluid. Of the 1184 infants presenting to the emergency department with chief complaints that may prompt an SBI evaluation, 579 patients met our inclusion criteria with 362 in the fever group and 217 in the afebrile group. The most common chief complaints in the afebrile group were respiratory symptoms (27%), seizure (22%), vomiting/diarrhea (21%), and apparent life-threatening event (11%). Rates of true-positive blood, urine, and cerebrospinal fluid cultures were 2%, 2.4%, and 0.9% respectively. All cases of bacterial meningitis were in the fever group antibiotics (P = 0.16). Infants with fever were more likely to receive antibiotics (P < 0.001), although there were no statistical differences between the 2 groups in the rates of positive blood or urine cultures.
Afebrile infants make up a significant percentage of SBI evaluations in the emergency department. Respiratory symptoms, vomiting, and seizure-like activity are common presentations. Although rates of bacteremia and urinary tract infection are higher in the febrile group, this did not reach statistical significance, and therefore afebrile infants should still be considered at risk for SBI.
有时会对0至60日龄的无发热婴儿进行严重细菌感染（SBI）评估。我们的目的是描述该人群的临床和实验室检查结果，并将其与发热婴儿进行比较。
我们进行了一项回顾性观察研究，将接受SBI评估的无发热婴儿与因发热接受评估的婴儿进行比较。
我们纳入了入院且进行了以下三种细菌培养中至少两种的婴儿：血液、尿液或脑脊液。在1184名因可能提示SBI评估的主要症状到急诊科就诊的婴儿中，579名患者符合我们的纳入标准，其中发热组362名，无发热组217名。无发热组最常见的主要症状是呼吸道症状（27%）、惊厥（22%）、呕吐/腹泻（21%）和明显危及生命的事件（11%）。血培养、尿培养和脑脊液培养的真阳性率分别为2%、2.4%和0.9%。所有细菌性脑膜炎病例均在发热组接受了抗生素治疗（P = 0.16）。发热婴儿更有可能接受抗生素治疗（P < 0.001），尽管两组血培养或尿培养阳性率无统计学差异。
无发热婴儿在急诊科SBI评估中占相当大的比例。呼吸道症状、呕吐和类似惊厥的活动是常见表现。虽然发热组的菌血症和尿路感染发生率较高，但未达到统计学意义，因此无发热婴儿仍应被视为有SBI风险。
