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Ishraq F, Subhi R. Are lumbar punctures required for infants with bacteraemic urinary tract infections? Arch Dis Child 2024:archdischild-2024-327315. [PMID: 38950905 DOI: 10.1136/archdischild-2024-327315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 06/18/2024] [Indexed: 07/03/2024]
Affiliation(s)
- Farhan Ishraq
- Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Rami Subhi
- General Paediatrics, Northern Health, Melbourne, Victoria, Australia
- The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia
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Velasco R, Lejarzegi A, Andina D, Gomez B, Izarzugaza E, Mintegi S. Multicentre Delphi study of physicians resulted in quality indicators for young infants with fever without source in emergency departments. Acta Paediatr 2023; 112:1962-1969. [PMID: 37203258 DOI: 10.1111/apa.16851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 05/20/2023]
Abstract
AIM Managing febrile infants has evolved without a generally accepted standard of care. We aimed to design quality indicators for managing infants ≤90 days old presenting to emergency departments (EDs) with fever without source. METHODS This multicentre Delphi study was carried out by the Febrile Infant Study Group of the Spanish Paediatric Emergency Research Network, from March 2021 to November 2021, and included paediatric emergency physicians from 24 Spanish EDs. A list of care standards was produced, following an extensive literature review and the involvement of all parties. Indicators were essential if they were voted by four panelists and also received a score of ≥4 from at least 95% of the 24 investigators. RESULTS We established 20 indicators, including one related to having a protocol, two to triage, nine to diagnostic processes, six to treatment and two to disposition. The following indicators were considered essential: having an ED management protocol, performing urinalysis on every infant, obtaining a blood culture from every infant and administering antibiotics in the ED to any febrile infant who did not appear well. CONCLUSION The Delphi method resulted in a comprehensive list of quality indicators for managing febrile young infants in Spanish EDs.
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Affiliation(s)
- Roberto Velasco
- Paediatric Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Ainara Lejarzegi
- Paediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - David Andina
- Paediatric Emergency Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Borja Gomez
- Paediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - Estíbaliz Izarzugaza
- Subdirectorate of Innovation and Quality, Hospital Universitario Cruces, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - Santiago Mintegi
- Paediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country (UPV/EHU), Bilbao, Spain
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Li SY, Yin CH, Chen JS, Chen YS, Yang CC, Fang NW, Wang HP, Chiou YH. A nomogram for predicting the development of serious bacterial infections in febrile term neonates: A single medical center experience in Southern Taiwan. Pediatr Neonatol 2022; 63:605-612. [PMID: 36008242 DOI: 10.1016/j.pedneo.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/04/2022] [Accepted: 07/07/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Serious bacterial infections (SBIs) could lead to mortality or severe long-term sequelae in neonates and infants aged <3 months. Accordingly, the aim of this study was to develop a quantitative and accurate assessment tool for predicting the risk of SBIs in febrile neonates. METHODS This retrospective study enrolled 131 febrile term neonates (aged <30 days) who were hospitalized at Kaohsiung Veterans General Hospital between January 2005 and December 2020. These neonates were classified into SBI and nonbacterial infection (NBI) groups on the basis of microbiological laboratory reports. The clinical characteristics and routine blood tests of both groups at the time of admission were analyzed. Stepwise logistic regression was applied to create and validate the nomogram for SBI prediction. RESULTS Among the 131 febrile neonates, 38 and 93 developed SBIs and NBIs, respectively. At the time of admission, ill clinical appearance, serum myelocyte/metamyelocyte presence, C-reactive protein (CRP) > 2.5 mg/dL, and pyuria were associated with an increased risk of SBIs. Accordingly, these four factors were used to develop a nomogram for SBI prediction, which exhibited significantly high performance (area under curve = 0.848, p < 0.001) in predicting SBI risk. CONCLUSION We developed a nomogram combining clinical appearance, serum myelocyte/metamyelocyte presence, CRP, and pyuria for predicting SBI risk in febrile neonates. This tool can assist clinicians in making early diagnoses and delivering the appropriate treatment.
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Affiliation(s)
- Shin-Ying Li
- Division of Pediatric Neonatology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chun-Hao Yin
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Taiwan; Institute of Health Care Management, National Sun Yat-sen University, Taiwan
| | - Jin-Shuen Chen
- Department of Administration, Kaohsiung Veterans General Hospital, Taiwan
| | - Yao-Shen Chen
- Department of Administration, Kaohsiung Veterans General Hospital, Taiwan
| | - Chih-Chieh Yang
- Division of Pediatric Neonatology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Nai-Wen Fang
- Division of Pediatric Nephrology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hsiao-Ping Wang
- Division of Pediatric Neonatology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yee-Hsuan Chiou
- Division of Pediatric Nephrology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Medical Laboratory Science and Biotechnology, Fooyin University, Kaohsiung, Taiwan.
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Jamieson JM, Williams TC. Is a lumbar puncture a necessary investigation in a 2-month-old infant with a probable urinary tract infection? Arch Dis Child 2021; 106:1138-1140. [PMID: 34215650 DOI: 10.1136/archdischild-2021-322436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/12/2021] [Indexed: 11/03/2022]
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Velasco R, Lejarzegi A, Gomez B, de la Torre M, Duran I, Camara A, de la Rosa D, Manzano S, Rodriguez J, González A, Lopes AA, Rivas A, Martinez I, Angelats CM, Moya S, Corral S, Alonso J, Del Rio P, Sancho E, Ruiz Del Olmo I, Nieto I, Vega B, Mintegi S. Febrile young infants with abnormal urine dipstick at low risk of invasive bacterial infection. Arch Dis Child 2021; 106:758-763. [PMID: 33246922 DOI: 10.1136/archdischild-2020-320468] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/04/2020] [Accepted: 11/11/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To develop and validate a prediction rule to identify well-appearing febrile infants aged ≤90 days with an abnormal urine dipstick at low risk of invasive bacterial infections (IBIs, bacteraemia or bacterial meningitis). DESIGN Ambispective, multicentre study. SETTING The derivation set in a single paediatric emergency department (ED) between 2003 and 2017. The validation set in 21 European EDs between December 2017 and November 2019. PATIENTS Two sets of well-appearing febrile infants aged ≤90 days with an abnormal urine dipstick (either leucocyte esterase and/or nitrite positive test). MAIN OUTCOME Prevalence of IBI in low-risk infants according to the RISeuP score. RESULTS We included 662 infants in the derivation set (IBI rate:5.2%). After logistic regression, we developed a score (RISeuP score) including age (≤15 days old), serum procalcitonin (≥0.6 ng/mL) and C reactive protein (≥20 mg/L) as risk factors. The absence of any risk factor had a sensitivity of 96.0% (95% CI 80.5% to 99.3%), a negative predictive value of 99.4% (95% CI 96.4% to 99.9%) and a specificity of 32.9% (95% CI 28.8% to 37.3%) for ruling out an IBI. Applying it in the 449 infants of the validation set (IBI rate 4.9%), sensitivity, negative predictive value and specificity were 100% (95% CI 87.1% to 100%), 100% (95% CI 97.3% to 100%) and 29.7% (95% CI 25.8% to 33.8%), respectively. CONCLUSION This prediction rule accurately identified well-appearing febrile infants aged ≤90 days with an abnormal urine dipstick at low risk of IBI. This score can be used to guide initial clinical decision-making in these patients, selecting infants suitable for an outpatient management.
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Affiliation(s)
- Roberto Velasco
- Pediatric Emergency Unit, Rio Hortega University Hospital, Valladolid, Spain
| | - Ainara Lejarzegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces. University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Borja Gomez
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces. University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Mercedes de la Torre
- Pediatric Emergency Department, Hospital Infantil Universitario Nino Jesus, Madrid, Madrid, Spain
| | - Isabel Duran
- Pediatric Emergency Department, Hospital Regional Universitario de Malaga, Malaga, Spain
| | - Amaia Camara
- Pediatric Emergency Department, Donostia Ospitalea, Donostia, Spain
| | - Daniel de la Rosa
- Pediatric Emergency Department, Hospital Universitario Materno Infantil de Canarias, Las Palmas Gran Canaria, Spain
| | - Sergio Manzano
- Pediatric Emergency Department, Geneva University Hospital, Geneva, Switzerland
| | - Jose Rodriguez
- Pediatrics, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | | | - Anne-Aurelie Lopes
- Pediatric Emergency Department, Robert-Debré Mother-Child University Hospital. Sorbonne University, Paris, France
| | - Aristides Rivas
- Pediatric Emergency Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - Isabel Martinez
- Pediatric Emergency Department, Virgen del Rocio University Hospital, Sevilla, Spain
| | | | - Sandra Moya
- Pediatric Emergency Department, Parc Taulí University Hospital, Sabadell, Spain
| | - Sonia Corral
- Pediatrics, Granollers General Hospital, Granollers, Spain
| | - Juan Alonso
- Pediatrics, Hospital San Agustín, Linares, Spain
| | | | - Elena Sancho
- Pediatrics, Hospital de San Jorge, Huesca, Spain
| | | | - Inmaculada Nieto
- Pediatrics, Hospital San Juan de Dios del Aljarafe, Sevilla, Spain
| | - Beatriz Vega
- Pediatrics, Hospital Comarcal de Laredo, Laredo, Spain
| | - Santiago Mintegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces. University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
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Liu CE, Pan YM, Du ZL, Wu C, Hong XY, Sun YH, Li HF, Liu J. Composition characteristics of the gut microbiota in infants and young children of under 6 years old between Beijing and Japan. Transl Pediatr 2021; 10:790-806. [PMID: 34012829 PMCID: PMC8107842 DOI: 10.21037/tp-20-376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The composition of intestinal flora in Chinese and Japanese has been reported in many studies but that in infants aged 0-6 years old has not been studied yet. METHODS The distribution characteristics of the fecal flora of infants in Beijing (n=84) and Japan (n=53) were analyzed using 16S rRNA gene sequencing analysis. RESULTS This study showed the higher relative abundance of Erysipelotrichaceae_ UCG-003 and Anaerostipes in male group that of Ruminiclostridium, Eubacterium, Senegalimassilia and Senegalimassilia in female group, especially Senegalimassilia, which was not detected in male group. Defecation trait groups indicated significantly higher relative abundance of Bifidobacterium in abnormal bowel trait group than that in the normal group (P<0.05). The feeding groups' analysis showed significantly higher relative abundance of Bifidobacterium and Enterococcus and lower abundance of Bacteroides and Lacetospirillaceae in the breast-feeding group than that in the formula feeding and mixed-feeding groups. The relative abundance of Parasutterella and Ruminococcaceae_UCG-003 in the halitosis group was significantly higher than that in the normal group. The comparison of cold and fever group and normal group indicated significantly higher relative abundance of Erysipelatoclostridium and lower relative abundance of Lachnospiraceae _UCG-001 in the fever and cold group than that in the normal group (P<0.05). The regional comparison of intestinal flora of Beijing and Japan showed significant increase in the relative abundance of Bacillus, Lactobacillus, Prevotella, megamonas and Veillonella in the intestinal flora of 0-6 years old infants in Beijing. CONCLUSIONS These findings improve the understanding of intestinal bacterial and viral communities of infants from the two Asian countries.
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Affiliation(s)
- Chang-E Liu
- Department of Nutrition, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yuan-Ming Pan
- Department of Gastroenterology, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhen-Lan Du
- Department of Hematology and Oncology, Faculty of Pediatrics, Chinese PLA General Hospital, Beijing, China
| | - Cong Wu
- Department of Nutrition, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiao-Yang Hong
- Department of Critical Care Medicine, Faculty of Pediatrics, Chinese PLA General Hospital, Beijing, China
| | - Yan-Hui Sun
- Department of Nutrition, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hai-Feng Li
- Department of Health Services, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jie Liu
- Department of Laboratory, the Seventh Medical Center of PLA General Hospital, Beijing, China
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Thattil SJ, Ajith T. Bacteriological and antibiotic profile of infection among infants in the post-neonatal period at a tertiary care hospital in South India. JOURNAL OF HEALTH RESEARCH 2021. [DOI: 10.1108/jhr-03-2020-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PurposeSevere bacterial infection is a major cause of neonatal morbidity and mortality worldwide. Geographical-based demographic laboratory and clinical data are required to get a conclusion about the bacterial infection and their antibiotic susceptibility for the empiric antibiotic treatment in infants who presented with suspected infection. This study was aimed to find the most prevalent bacterial infection and antibiotic sensitivity among infants in the post-neonatal period presented at a tertiary care centre in South India.Design/methodology/approachA cross-sectional study was designed among infants (29 days to 1 year old) presented with suspected infection in the paediatric department. Infants with positive culture report were analysed for the bacteriological and antibiotic profile from the medical records. Antibiotic sensitivity was determined for the isolated bacteria according to standard procedure and data statically analysed.FindingsTotal of 218 samples (138 male and 80 female) were analysed. Most of the samples (171/218, 78.4%) were throat swab (p = 0.0247). Only one sample was cerebrospinal fluid from case of meningitis. Sample from upper RTI was major (162/218, 74.3%) with male dominance followed by stool samples from cases of diarrhoea (22/218, 10.0%). Staphylococcus aureus was the major organism identified in 46/171 (26.9 %) throat swabs. The most sensitive antibiotic against bacteria isolated from throat swab and CSF was gentamicin and cloxacillin. Netilmicin and piperacillin plus tazobactam were the sensitive antibiotics against bacteria isolated from stool, ear secretion and urine samples.Originality/valueUpper RTI was the prevalent bacterial infection followed by diarrhoea in infants in the post-neonatal period. Klebsiella pneumoniae was the common organism identified in the overall report followed by E. coli and S. aureus. Community-based awareness should be provided to follow good hygiene regularly in child care. Furthermore, avoid delay in seeking treatment and provide the medicine prescribed at the right time and in the right dose to limit the morbidity and bacterial resistance.
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Aronson PL, Politi MC, Schaeffer P, Fleischer E, Shapiro ED, Niccolai LM, Alpern ER, Bernstein SL, Fraenkel L. Development of an App to Facilitate Communication and Shared Decision-making With Parents of Febrile Infants ≤ 60 Days Old. Acad Emerg Med 2021; 28:46-59. [PMID: 32648270 DOI: 10.1111/acem.14082] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/21/2020] [Accepted: 07/07/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES We aimed to develop and test a tool to engage parents of febrile infants ≤ 60 days of age evaluated in the emergency department (ED). The tool was designed to improve communication for all parents and to support shared decision-making (SDM) about whether to perform a lumbar puncture (LP) for infants 29 to 60 days of age. METHODS We conducted a multiphase development and testing process: 1) individual, semistructured interviews with parents and clinicians (pediatric and general emergency medicine [EM] physicians and pediatric EM nurses) to learn their preferences for a communication and SDM tool; 2) design of a "storyboard" of the tool with design impression testing; 3) development of a software application (i.e., app) prototype, called e-Care; and 4) usability testing of e-Care, using qualitative assessment and the system usability scale (SUS). RESULTS We interviewed 27 parents and 23 clinicians. Interviews revealed several themes, including that a communication tool should augment but not replace verbal communication; a Web-based format was preferred; and information about infections and testing, including the rationales for specific tests, would be valuable. We then developed separate versions of e-Care for infants ≤ 28 days and 29 to 60 days of age, in both English and Spanish. The e-Care app includes four sections: 1) homepage; 2) why testing is done; 3) what tests are done; and 4) what happens after testing, including a table for parents of infants 29 to 60 days of age to compare the risks/benefits of LP in preparation for an SDM conversation. Parents and clinicians reported that e-Care was understandable and helpful. The mean SUS score was 90.3 (95% confidence interval = 84 to 96.6), representing "excellent" usability. CONCLUSIONS The e-Care app is a useable and understandable tool to support communication and SDM with parents of febrile infants ≤ 60 days of age in the ED.
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Affiliation(s)
- Paul L. Aronson
- From the Department of PediatricsYale School of Medicine New HavenCTUSA
- the Department of Emergency Medicine Yale School of Medicine New Haven CTUSA
| | - Mary C. Politi
- the Department of Surgery Division of Public Health Sciences School of Medicine Washington University St. Louis MOUSA
| | - Paula Schaeffer
- From the Department of PediatricsYale School of Medicine New HavenCTUSA
| | - Eduardo Fleischer
- From the Department of PediatricsYale School of Medicine New HavenCTUSA
| | - Eugene D. Shapiro
- From the Department of PediatricsYale School of Medicine New HavenCTUSA
- the Department of Epidemiology of Microbial Diseases Yale School of Public Health Yale School of Public Health New Haven CTUSA
| | - Linda M. Niccolai
- the Department of Epidemiology of Microbial Diseases Yale School of Public Health Yale School of Public Health New Haven CTUSA
| | - Elizabeth R. Alpern
- the Department of Pediatrics, Division of Emergency Medicine Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine Chicago ILUSA
| | - Steven L. Bernstein
- the Department of Emergency Medicine Yale School of Medicine New Haven CTUSA
- and the Yale Center for Implementation Science Yale School of Medicine New Haven CTUSA
| | - Liana Fraenkel
- and the Department of Internal Medicine Yale School of Medicine New Haven CTUSA
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Fever Without an Apparent Source in Young Infants: A Multicenter Retrospective Evaluation of Adherence to the Dutch Guidelines. Pediatr Infect Dis J 2020; 39:1075-1080. [PMID: 32858646 DOI: 10.1097/inf.0000000000002878] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Dutch fever without an apparent source (FWS) guidelines were published to timely recognize and treat serious infections. We determined the adherence to the Dutch FWS guidelines and the percentage of serious infections in infants younger than 3 months of age. Second, we identified which clinical criteria, diagnostic tests, and management were associated with nonadherence to the guidelines. METHODS A retrospective cohort study was performed in 2 Dutch teaching hospitals. We assessed the charts of all infants with FWS who presented at the emergency departments from September 30, 2017, to October 1, 2019. Diagnostic and therapeutic decisions were compared with the recommendations, as published in the Dutch guidelines. Infants were categorized into the nonadherence group in case 1 or more recommendations were not adhered to. RESULTS Data on 231 infants were studied; 51.5% of the cases adhered to the Dutch guidelines and 16.0% suffered from a serious infection. The percentage of infants with a serious infection was higher in the adherence compared with the nonadherence group. We observed no relevant differences in clinical outcomes. Univariate regression analysis showed that an abnormal white blood cell count was associated with nonadherence (OR 0.4, P = 0.049). Not obtaining a urine and blood culture and not starting intravenous antibiotic treatment were the most frequent reasons for nonadherence to the guidelines. CONCLUSIONS Our study indicates that there was nonadherence in a large proportion of FWS cases. The guidelines may need to be adjusted to increase adherence.
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Abstract
BACKGROUND Our objectives were to determine the prevalence of and to identify risk factors for coexisting bacterial meningitis (BM) in neonates with urinary tract infection (UTI). METHODS A cross-sectional study was conducted at pediatric emergency department of a tertiary teaching hospital from 2001 to 2017. Infants <29 days of age with UTI (≥10,000 colony-forming units/mL of a single pathogen from a catheterized specimen in association with positive urinalysis) were included. Definite BM was defined as growth of a single bacterial pathogen from a cerebrospinal fluid (CSF) sample and probable BM as (1) positive blood culture with CSF pleocytosis and treatment consistent with BM or (2) antibiotic pretreatment before lumbar puncture, CSF pleocytosis and treatment consistent with BM. Univariate testing was used to identify possible risk factors associated with BM. Receiver operating characteristics curves were constructed for the laboratory markers associated with BM. RESULTS Three hundred seventy-one infants were included. Five [1.3%; 95% confidence interval (CI): 0.6%-3.1%] had BM: 4 definite BM and 1 probable BM. Risk factors detected for BM were classified as not being well-appearing and a procalcitonin value ≥0.35 ng/mL [sensitivity of 100% (95% CI: 56.6%-100%) and negative predictive value of 100% (95% CI: 96.1%-100%)]. CONCLUSIONS Coexisting BM occurs uncommonly in neonates with UTI. Well-appearing neonates with UTI and procalcitonin value <0.35 ng/mL were at very low risk for BM; avoiding routine lumbar puncture in these patients should be considered.
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