Department of Emergency Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York;
Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
Pediatrics. 2021 Jan;147(1). doi: 10.1542/peds.2020-1571. Epub 2020 Dec 7.
To determine the prevalence of invasive bacterial infections (IBIs) and adverse events in afebrile infants with acute otitis media (AOM).
We conducted a 33-site cross-sectional study of afebrile infants ≤90 days of age with AOM seen in emergency departments from 2007 to 2017. Eligible infants were identified using emergency department diagnosis codes and confirmed by chart review. IBIs (bacteremia and meningitis) were determined by the growth of pathogenic bacteria in blood or cerebrospinal fluid (CSF) culture. Adverse events were defined as substantial complications resulting from or potentially associated with AOM. We used generalized linear mixed-effects models to identify factors associated with IBI diagnostic testing, controlling for site-level clustering effect.
Of 5270 infants screened, 1637 met study criteria. None of the 278 (0%; 95% confidence interval [CI]: 0%-1.4%) infants with blood cultures had bacteremia; 0 of 102 (0%; 95% CI: 0%-3.6%) with CSF cultures had bacterial meningitis; 2 of 645 (0.3%; 95% CI: 0.1%-1.1%) infants with 30-day follow-up had adverse events, including lymphadenitis (1) and culture-negative sepsis (1). Diagnostic testing for IBI varied across sites and by age; overall, 278 (17.0%) had blood cultures, and 102 (6.2%) had CSF cultures obtained. Compared with infants 0 to 28 days old, older infants were less likely to have blood cultures ( < .001) or CSF cultures ( < .001) obtained.
Afebrile infants with clinician-diagnosed AOM have a low prevalence of IBIs and adverse events; therefore, outpatient management without diagnostic testing may be reasonable.
确定无发热急性中耳炎（AOM）婴儿中侵袭性细菌感染（IBI）和不良事件的发生率。
我们对 2007 年至 2017 年间在急诊科就诊的≤90 天龄、有 AOM 症状且无发热的婴儿进行了一项 33 个地点的横断面研究。使用急诊诊断代码识别符合条件的婴儿，并通过图表审查进行确认。通过血液或脑脊液（CSF）培养中致病性细菌的生长确定 IBI（菌血症和脑膜炎）。不良事件定义为由 AOM 引起或可能与之相关的严重并发症。我们使用广义线性混合效应模型来识别与 IBI 诊断检测相关的因素，同时控制地点水平的聚类效应。
在筛选的 5270 名婴儿中，有 1637 名符合研究标准。278 名（0%；95%置信区间[CI]：0%-1.4%）血培养婴儿中无 1 例菌血症；102 名（0%；95%CI：0%-3.6%）CSF 培养婴儿中无 1 例细菌性脑膜炎；645 名有 30 天随访的婴儿中仅有 2 例（0.3%；95%CI：0.1%-1.1%）发生不良事件，包括淋巴结炎（1 例）和培养阴性败血症（1 例）。IBI 的诊断检测在各地点和年龄之间存在差异；总体而言，有 278 名（17.0%）进行了血培养，102 名（6.2%）进行了 CSF 培养。与 0 至 28 天龄的婴儿相比，年龄较大的婴儿进行血培养（<0.001）或 CSF 培养（<0.001）的可能性较低。
有临床诊断 AOM 的无发热婴儿 IBI 和不良事件的发生率较低；因此，无需诊断检测的门诊治疗可能是合理的。
