Browne G J, Ryan J M, McIntyre P
Emergency Department, Westmead Hospital, Australia.
Arch Dis Child. 1997 Feb;76(2):129-33. doi: 10.1136/adc.76.2.129.
A protocol for management of young febrile children at risk for bacteraemia has been used at Westmead Hospital, a university based hospital in the western Sydney region, since early 1994. Implementation of the protocol was retrospectively evaluated for the 12 month period 1 June 1994 to 31 May 1995, using the emergency department log book as the primary data source. Altogether 498 children, aged from 3 months to 3 years, with a fever > or = 39.5 degrees C were identified over this period, of whom 291 were admitted to hospital because of evidence of sepsis or identified focal infection and 207 children without focal infection were observed in the short stay annexe of the emergency department. Fifty children, considered at high risk of bacteraemia because of a total white cell count > or = 20 x 10(9)/1 received empiric antibiotic treatment with ceftriaxone, of whom 19 subsequently had proved bacteraemia and another 10 had focal infection identified during observation in the short stay annexe. Bacteraemia was due to Streptococcus pneumoniae in 16 cases and Haemophilus influenzae type b in three. No adverse events occurred at follow up. Use of a management protocol and selection on higher white cell count criterion than previously recommended by US centres resulted in restriction of empiric antibiotic treatment to a small proportion of young febrile children presenting to a busy emergency department of whom 38% were bacteraemic.
自1994年初以来，悉尼西区一家大学附属医院韦斯特米德医院一直采用一种针对有菌血症风险的发热幼儿的管理方案。以急诊科日志为主要数据源，对1994年6月1日至1995年5月31日这12个月期间该方案的实施情况进行了回顾性评估。在此期间，共识别出498名年龄在3个月至3岁之间、体温≥39.5摄氏度的儿童，其中291名因败血症证据或已确定的局灶性感染而入院，207名无局灶性感染的儿童在急诊科的短期观察区接受观察。50名因白细胞总数≥20×10⁹/L而被认为有菌血症高风险的儿童接受了头孢曲松的经验性抗生素治疗，其中19名随后被证实患有菌血症，另有10名在短期观察区观察期间被确定有局灶性感染。菌血症由肺炎链球菌引起的有16例，由b型流感嗜血杆菌引起的有3例。随访期间未发生不良事件。采用一种管理方案并根据高于美国中心先前推荐的白细胞计数标准进行选择，使得经验性抗生素治疗仅限于一小部分到繁忙急诊科就诊的发热幼儿，其中38%患有菌血症。
