This article is more than 5 years old. Information may no longer be current.
Leukopenia fails to reliably indicate bacterial infection in febrile children
Leukopenia in febrile children who appeared healthy when visiting the ED did not reliably indicate bacterial infection and should not function as the determining factor for antibiotic use, according to recent data in The Pediatric Infectious Disease Journal.
“Well-appearing infants 90 days of age [or younger] with [fever without a source (FWS)] and leukopenia can be managed in a similar way to those with a normal white blood cell count, avoiding unnecessary admissions and use of antibiotics when this is the only abnormal blood biomarker,” Borja Gomez, MD, of the pediatric ED at Cruces University Hospital, Spain, and colleagues wrote. “Leukopenia … should not be considered a risk factor for having a bacterial infection.”
The researchers studied febrile children aged younger than 90 days (n = 3,401) presenting to 19 EDs from October 2011 to September 2013. Patients with fever without a determined source were analyzed for invasive bacterial infection and noninvasive bacterial infection, compared with their appearance and leukocyte count.
Two hundred forty-four patients exhibited leukopenia, 2,369 had a normal leukocyte count, and 790 were diagnosed with leukocytosis. The researchers said 680 patients were diagnosed with noninvasive bacterial infections, while 107 were diagnosed with invasive bacterial infections.
Of the children who appeared well (n = 3,034), those with leukopenia had a lower rate of noninvasive bacterial infection (OR = 0.51; 95% CI, 0.29-0.88). The difference in the prevalence of invasive bacterial infections in well-appearing children with leukopenia was not significantly different, when compared with children with a normal leukocyte count (OR = 1.2; 95% CI, 0.44-3.44). However, of the patients who did not appear well (n = 367), those with leukopenia had a similar rate of noninvasive bacterial infection (OR = 0.57; 95% CI, 0.16-1.79) and a higher rate of invasive bacterial infection (OR = 2.9; 95% CI, 1.06-7.78).
“The main limitation of our study is that the value of leukopenia for identifying patients with a higher risk of having a bacterial infection depends on general appearance,” Gomez and colleagues wrote. “Given this, our results cannot be extrapolated to hospitals where patients are assessed by less experienced personnel, who may not make a correct assessment of the general appearance.” – by David Costill
Disclosure: The researchers report no relevant financial disclosures.
