Aronson Paul L, McCulloh Russell J, Tieder Joel S, Nigrovic Lise E, Leazer Rianna C, Alpern Elizabeth R, Feldman Elana A, Balamuth Fran, Browning Whitney L, Neuman Mark I
Division of Infectious Diseases, Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO.
Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Pediatr Emerg Care. 2019 Jan;35(1):22-27. doi: 10.1097/PEC.0000000000001421.
The Rochester criteria were developed to identify febrile infants aged 60 days or younger at low-risk of bacterial infection and do not include cerebrospinal fluid (CSF) testing. Prior studies have not specifically assessed criteria performance for bacteremia and bacterial meningitis (invasive bacterial infection). Our objective was to determine the sensitivity of the Rochester criteria for detection of invasive bacterial infection.
Retrospective cohort study of febrile infants aged 60 days or younger with invasive bacterial infections evaluated at 8 pediatric emergency departments from July 1, 2012, to June 30, 2014. Potential cases were identified from the Pediatric Health Information System using International Classification of Diseases, Ninth Revision diagnosis codes for bacteremia, meningitis, urinary tract infection, and fever. Medical record review was then performed to confirm presence of an invasive bacterial infection and to evaluate the Rochester criteria: medical history, symptoms or ill appearance, results of urinalysis, complete blood count, CSF testing (if obtained), and blood, urine, and CSF culture. An invasive bacterial infection was defined as growth of pathogenic bacteria from blood or CSF culture.
Among 82 febrile infants aged 60 days or younger with invasive bacterial infection, the sensitivity of the Rochester criteria were 92.7% (95% confidence interval [CI], 84.9%-96.6%) overall, 91.7% (95% CI, 80.5%-96.7%) for neonates 28 days or younger, and 94.1% (95% CI, 80.9%-98.4%) for infants aged 29 to 60 days old. Six infants with bacteremia, including 1 neonate with bacterial meningitis, met low-risk criteria.
The Rochester criteria identified 92% of infants aged 60 days or younger with invasive bacterial infection. However, 1 neonate 28 days or younger with meningitis was classified as low-risk.
罗切斯特标准旨在识别60日龄及以下细菌性感染低风险的发热婴儿，且不包括脑脊液（CSF）检测。既往研究未专门评估该标准对菌血症和细菌性脑膜炎（侵袭性细菌感染）的表现。我们的目的是确定罗切斯特标准对检测侵袭性细菌感染的敏感性。
对2012年7月1日至2014年6月30日在8家儿科急诊科评估的60日龄及以下患有侵袭性细菌感染的发热婴儿进行回顾性队列研究。使用国际疾病分类第九版中菌血症、脑膜炎、尿路感染和发热的诊断编码，从儿科健康信息系统中识别潜在病例。然后进行病历审查，以确认侵袭性细菌感染的存在并评估罗切斯特标准：病史、症状或病容、尿液分析结果、全血细胞计数、脑脊液检测（如果进行了）以及血液、尿液和脑脊液培养。侵袭性细菌感染定义为血液或脑脊液培养中病原菌生长。
在82例60日龄及以下患有侵袭性细菌感染的发热婴儿中，罗切斯特标准的总体敏感性为92.7%（95%置信区间[CI]，84.9%-96.6%），28日龄及以下新生儿为91.7%（95%CI，80.5%-96.7%），29至60日龄婴儿为94.1%（95%CI，80.9%-98.4%）。6例菌血症婴儿，包括1例患有细菌性脑膜炎的新生儿，符合低风险标准。
罗切斯特标准识别出了92%的60日龄及以下患有侵袭性细菌感染的婴儿。然而，1例28日龄及以下患有脑膜炎的新生儿被归类为低风险。
