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Prediction rule IDs infants at low-risk for serious bacterial infection
The use of urinalysis, absolute neutrophil count and procalcitonin levels accurately identified young infants at low risk for serious bacterial infection, according to research published in JAMA Pediatrics.
Nathan Kuppermann, MD, MPH, professor of emergency medicine and pediatrics at the University of California, Davis, and colleagues wrote that fever may be the only sign that an infant has a serious bacterial infection, or SBI, and that clinical observation often fails to detect infants with invasive bacterial infection such as bacteremia and meningitis. Additionally, no lab tests can accurately identify all infants with SBIs.
“The incidence of SBIs in infants has decreased over time, making it imperative to balance the consequences of missed SBIs with risks of hospital-related complications, costs and potential increases in antimicrobial resistance owing to empirical antibiotic treatment,” the researchers wrote.
Kuppermann and colleagues conducted a prospective, observational study that included previously healthy febrile infants aged 60 days and younger who were examined for SBIs at 26 EDs. All infants were examined between March 2011 and May 2013.
The prediction rule was derived from a random cohort of 908 infants and was validated on 913 infants. SBIs were identified in 170 infants, including bacteremia (1.4%), urinary tract infections (8.3%) and bacterial meningitis (0.5%). Concurrent SBIs were found in 0.9% of infants.
According to the researchers, the prediction rule was able to identify patients at low risk for SBI using a negative urinalysis result, an absolute neutrophil count of 4090/µg or less and serum procalcitonin of 1.7 ng/mL or less. The sensitivity of the rule was 97.7% (95% CI, 91.3-99.6) and the specificity was 60% (95% CI, 56.6-63.3) after validation. The prediction rule also had a negative predictive value of 99.6% (95% CI, 98.4-99.9) and a negative likelihood ratio of 0.04 (95% CI, 0.01-0.15).
Three infants were misclassified when the prediction rule was used, one of whom had bacteremia and two of whom had urinary tract infections. No infants with bacterial meningitis were missed.
“Once further validated, implementation of the rule has the potential to substantially decrease the use of lumbar punctures, broad-spectrum antibiotics and hospitalization for many febrile infants aged 60 days and younger,” Kuppermann and colleagues wrote. – by Katherine Bortz
Disclosures: Kuppermann reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
