Article Data

  • Views 298
  • Dowloads 11

Original Research

Open Access

Diagnostic markers of serious bacterial infections in infants aged 29 to 90 days

  • SANGSOO HAN1
  • SUNGWOO CHOI1
  • YOUNG SOON CHO 1

1Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea

DOI: 10.22514/SV151.042019.2 Vol.15,Issue 1,April 2019 pp.22-26

Published: 23 April 2019

*Corresponding Author(s): YOUNG SOON CHO E-mail: emer0717@gmail.com

Abstract

Objectives: The diagnosis of serious bacte-rial infection (SBI) is difficult due to a lack of clinical evidence. The purpose of this study was to determine which inflamma-tory markers can be used to detect SBI in febrile infants.

Methods: This retrospective cohort study included infants aged 29 to 90 days who visited a tertiary hospital emergency de-partment in Korea between July 2016 and June 2018. The diagnostic characteristics of the neutrophil-to-lymphocyte ratio (NLR), procalcitonin (PCT), C-reactive protein (CRP), white blood cell (WBC) count, and absolute neutrophil cell (ANC) count for detecting SBI were described. Their cutoff values were calculated based on receiver operating characteristic (ROC) curve analysis.

Results: Among 528 infants, 199 were finally enrolled. SBI was detected in 68 (34.2%) of these infants. The median val-ues of all investigated diagnostic markers were significantly higher in infants with SBI than the values in those without: WBC (12.72 vs. 9.91 k/μL), ANC (6.28 vs. 3.14 k/μL), CRP (26.6 vs. 2.8 mg/L), NLR (1.29 vs. 0.78), and PCT (0.5 vs. 0 ng/mL). The areas under the ROC curves for discriminating SBI were: 0.705 (95% confidence interval [CI], 0.629-0.781), 0.793 (95% CI, 0.731-0.856), 0.832 (95% CI, 0.775-0.889), 0.722 (95% CI, 0.651-0.792), and 0.695 (95% CI, 0.611-0.780) for WBC, ANC, CRP, NLR, and PCT, respectively. Using a cutoff value of 0.67 for NLR, the negative predictive value was 90.8% for identifying SBI. Conclusions: CRP was the best single dis-criminatory marker of SBI, while NLR was the best parameter for considering dis-charge.

Keywords

bacterial infection; urinary tract infection; clinical marker; discharge plan-ning 

Cite and Share

SANGSOO HAN,SUNGWOO CHOI,YOUNG SOON CHO . Diagnostic markers of serious bacterial infections in infants aged 29 to 90 days. Signa Vitae. 2019. 15(1);22-26.

References

1. Baraff LJ. Management of fever without source in infants and children. Ann Emerg Med 2000;36:602-614.

2. Milcent K, Faesch S, Gras-Le Guen C, Dubos F, Poulalhon C, Badier I, et al. Use of procalcitonin assays to predict serious bacterial infection in young febrile infants. JAMA Pediatr 2016;170:62-69.

3. Wilson CB. Immunologic basis for increased susceptibility of the neonate to infection. J Pediatr 1986;108:1-12.

4. Kadish HA, Loveridget B, Tobeyt J, Bolte RG, Corneli HM. Applying outpatient protocols in febrile infants 1-28 days of age: can the threshold be lowered? Clin Pediatr 2000;39:81-88.

5. Tintinalli JE, Stapczynski JS, John MO, et al. Tintinalli's Emergnecy Medicine. 18th ed. New York, NY: McGraw-Hill Education; 2016.

6. Hamiel U, Bahat H, Kozer E, Hamiel Y, Ziv-Baran T, Goldman M. Diagnostic markers of acute infections in infants aged 1 week to 3 months: a retrospective cohort study. BMJ Open 2018 Jan 24;8(1):e018092.

7. Cortese F, Scicchitano P, Gesualdo M, Filaninno A, Giorgi ED, Schettini F, et al. Early and late infections in newborns: where do we stand? A review. Pediatr Neonatol 2016;57:265-273.

8. Biondi EA, Byington CL. Evaluation and management of febrile, well-appearing young infants. Infect Dis Clin North Am 2015;29:575-585.

9. Olaciregui I, Hernandez U, Munoz JA, Emparanza JI, Landa JJ. Markers that predict serious bacterial infection in infants under 3 months of age presenting with fever of unknown origin. Arch Dis Child 2009;94:501-505.

10. Gomez B, Bressan S, Mintegi S, Dalt LD, Blazquez D, Olaciregui I, et al. Diagnostic value of procalcitonin in well-appearing young febrile infants. Pediatrics 2012;130:815-822.

11. Bilavsky E, Yarden‐Bilavsky H, Ashkenazi S, Amir J. C‐reactive protein as a marker of serious bacterial infections in hospitalized febrile infants. Acta Paediatr 2009;98:1776-1780.

12. Maniaci V, Dauber A, Weiss S, Nylen E, Becker KL, Bachur R. Procalcitonin in young febrile infants for the detection of serious bacte-rial infections. Pediatrics 2008;122:701-710.

13. Hubert-Dibon G, Danjou L, Feildel-Fournial C, Vrignaud B, Masson D, Launay E, et al. Procalcitonin and C-reactive protein may help to detect invasive bacterial infections in children who have fever without source. Acta Paediatr 2018;107:1262-1269.

14. Greenhow TL, Hung Y-Y, Herz AM, Losada E, Pantell RH. The changing epidemiology of serious bacterial infections in young in-fants. Pediatr Infect Dis J 2014;33:595-599.

15. Rushton HG. Urinary tract infections in children: epidemiology, evaluation, and management. Pediatr Clin North Am 1997;44:1133-1169.

16. Pantell RH, Newman TB, Bernzweig J, Bergman DA, Takayama JI, Segal M, et al. Management and outcomes of care of fever in early infancy. JAMA 2004;291:1203-1212.

17. Jaskiewicz JA, McCarthy CA, Richardson AC, White KC, Fisher DJ, Powell KR, et al. Febrile infants at low risk for serious bacterial infection--an appraisal of the Rochester criteria and implications for management. Febrile Infant Collaborative Study Group. Pedi-atrics 1994;94:390-396.

18. Baker MD, Bell LM, Avner JR. Outpatient management without antibiotics of fever in selected infants. N Engl J Med 1993;329:1437-1441.

19. Baskin MN, O'Rourke EJ, Fleisher GR. Outpatient treatment of febrile infants 28 to 89 days of age with intramuscular administration of ceftriaxone. J Pediatr 1992;120:22-27.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time

Conferences

    Top