AAP-backed markers can rule out invasive bacterial infections in febrile infants
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Key takeaways:
- Procalcitonin plus absolute neutrophil performed best in ruling out invasive bacterial infection.
- Using the AAP-backed markers can reduce unneeded lumbar punctures in low-risk infants.
Two AAP-recommended strategies can help physicians rule out invasive bacterial infections in febrile infants, which could reduce unnecessary lumbar punctures, but they were not as effective in younger infants, researchers found.
The strategies, which rely on combinations of inflammatory markers, also successfully identified infants with invasive bacterial infections, according to a study published in Pediatrics.
“The study aligns with previous results, but in a larger, multicenter cohort, that is more generalizable due to the inclusion of community and general hospitals in addition to academic centers,” Lyubina Yankova, MD, a clinical fellow in the section of pediatric hospital medicine at Yale New Haven Children’s Hospital and Yale School of Medicine, told Healio.
Yankova and colleagues studied data from the Reducing Excessive Variability in Infant Sepsis Evaluation II project, which evaluated how hospitals implemented AAP’s 2021 guidelines for managing fever in infants.
They analyzed inflammatory markers from 13,262 infants aged 8 to 60 days who presented with a fever at 106 hospitals from Nov. 1, 2020, to Oct. 31, 2022. They calculated the sensitivity, specificity, negative predictive value (NPV) and negative likelihood ratio (LR) of two different inflammatory marker combinations used to detect invasive bacterial infections:
- procalcitonin plus absolute neutrophil count, and
- maximum temperature, absolute neutrophil count and C-reactive protein.
Both combinations had sensitivity scores of 95% or higher, the researchers reported, demonstrating their ability to correctly identify infections. They had NPVs above 99.5% and LRs of 0.12 or lower among infants aged 22 to 60 days.
Procalcitonin plus absolute neutrophil count demonstrated higher overall specificity — or ability to rule out infections — compared with maximum temperature, neutrophil count and C-reactive protein (58.7%; 95% CI, 57.7-59.6 vs. 35.3%; 95% CI, 34.4-36.2). The specificity of procalcitonin plus absolute neutrophil count was more than 20 percentage points lower among infants aged 8 to 21 days vs. ages 22 to 60 days (40.1% vs. 63.2%).
Each combination misclassified one infant aged 22 to 60 days with meningitis as having a low risk for invasive bacterial infection, the authors noted.
The researchers also investigated the performance of procalcitonin plus absolute neutrophil count with the addition of C-reactive protein, which appeared to have lower specificity than procalcitonin plus absolute neutrophil count alone.
“The combination of procalcitonin and absolute neutrophil count has the highest specificity for detecting invasive bacterial infections, so its use as the inflammatory marker combination of choice may lead to less unnecessary lumbar punctures,” Yankova said. “Future research may be able to identify risk stratification algorithms in the 8- to 21-day-old group as well to similarly identify a sensitive and specific algorithm to reduce lumbar punctures in this younger age group.”
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