Diagnostic Practices for Sepsis Identification in Febrile Infants
Identification of most high-risk invasive bacterial infection relies on leukocytosis.
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SAN DIEGO — Diagnostic practices for diagnosing invasive bacterial infection in infants with fever were shown to vary based on infant age, and involved a wide range of imaging and laboratory testing that may not be informative, according to research presented at IDWeek 2017.
In this retrospective study, the charts of 83 infants aged between 0 and 90 days who presented with fever with no apparent source were reviewed over a 1-year period. Only infants with specific International Classification of Diseases codes were considered.
A total of 10% of the infants in the study had invasive bacterial infections, 75% of which were urinary tract infections.
Complete blood count, blood culture, urinalysis, and urine culture evaluation were performed in 84%, 87%, and 29% of infants between the ages of 0 and 28, 29 and 60, and 61 and 90 days, respectively. Abnormal complete blood count results were obtained in 64% of infants, with leukopenia as the most commonly reported abnormality.
Urinalysis collection and lumbar puncture attempts varied among the 3 age groups. These tests were most common in infants age 0 to 28 days and were least common in infants age 61 to 90 days.
Of the infants with invasive bacterial infections who underwent complete blood count evaluation, half had leukopenia while the other half had normal white blood cell counts.
Chest X-rays were obtained in 27% of infants; all were negative. Of the infants who underwent chest x-rays, 40% were asymptomatic.
The study investigators concluded that "[s]epsis evaluation in febrile infants varies tremendously and an updated guideline for identifying [invasive bacterial infections] could minimize unnecessary imaging, laboratory testing and unwarranted antibiotic therapy."
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Schmit K, Conway J, Allen A. Fever in infants: assessing variability in sepsis evaluation. Presented at: IDWeek 2017; October 4-8, 2017; San Diego, CA. Poster 2316.