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Lacroix L, Papis S, Mardegan C, Luterbacher F, L’Huillier A, Sahyoun C, Keitel K, Mastboim N, Etshtein L, Shani L, Simon E, Barash E, Navon R, Gottlieb TM, Oved K, Eden E, Combescure C, Galetto-Lacour A, Gervaix A. Host biomarkers and combinatorial scores for the detection of serious and invasive bacterial infection in pediatric patients with fever without source. PLoS One 2023; 18:e0294032. [PMID: 37956117 PMCID: PMC10642781 DOI: 10.1371/journal.pone.0294032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Improved tools are required to detect bacterial infection in children with fever without source (FWS), especially when younger than 3 years old. The aim of the present study was to investigate the diagnostic accuracy of a host signature combining for the first time two viral-induced biomarkers, tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) and interferon γ-induced protein-10 (IP-10), with a bacterial-induced one, C-reactive protein (CRP), to reliably predict bacterial infection in children with fever without source (FWS) and to compare its performance to routine individual biomarkers (CRP, procalcitonin (PCT), white blood cell and absolute neutrophil counts, TRAIL, and IP-10) and to the Labscore. METHODS This was a prospective diagnostic accuracy study conducted in a single tertiary center in children aged less than 3 years old presenting with FWS. Reference standard etiology (bacterial or viral) was assigned by a panel of three independent experts. Diagnostic accuracy (AUC, sensitivity, specificity) of host individual biomarkers and combinatorial scores was evaluated in comparison to reference standard outcomes (expert panel adjudication and microbiological diagnosis). RESULTS 241 patients were included. 68 of them (28%) were diagnosed with a bacterial infection and 5 (2%) with invasive bacterial infection (IBI). Labscore, ImmunoXpert, and CRP attained the highest AUC values for the detection of bacterial infection, respectively 0.854 (0.804-0.905), 0.827 (0.764-0.890), and 0.807 (0.744-0.869). Labscore and ImmunoXpert outperformed the other single biomarkers with higher sensitivity and/or specificity and showed comparable performance to one another although slightly reduced sensitivity in children < 90 days of age. CONCLUSION Labscore and ImmunoXpert demonstrate high diagnostic accuracy for safely discriminating bacterial infection in children with FWS aged under and over 90 days, supporting their adoption in the assessment of febrile patients.
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Affiliation(s)
- Laurence Lacroix
- Pediatric Emergency Department, Children’s Hospital, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sebastien Papis
- Department of General Pediatrics, Children’s Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Chiara Mardegan
- Department of General Pediatrics, Children’s Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Fanny Luterbacher
- Department of General Pediatrics, Children’s Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Arnaud L’Huillier
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Pediatric Infectious Diseases, Children’s Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Cyril Sahyoun
- Pediatric Emergency Department, Children’s Hospital, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Kristina Keitel
- Pediatric Emergency Department, Inselspital, Bern, Switzerland
| | | | | | | | | | | | | | | | | | | | - Christophe Combescure
- Department of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Annick Galetto-Lacour
- Pediatric Emergency Department, Children’s Hospital, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Alain Gervaix
- Pediatric Emergency Department, Children’s Hospital, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Galetto-Lacour A, Cordey S, Papis S, Mardegan C, Luterbacher F, Combescure C, Lacroix L, Gervaix A, Kaiser L, Posfay-Barbe KM, L’Huillier AG. Viremia as a predictor of absence of serious bacterial infection in children with fever without source. Eur J Pediatr 2023; 182:941-947. [PMID: 36399200 PMCID: PMC9672567 DOI: 10.1007/s00431-022-04690-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 10/19/2022] [Accepted: 11/02/2022] [Indexed: 11/21/2022]
Abstract
UNLABELLED Most children with fever without source (FWS) require diagnostic laboratory tests to exclude a serious bacterial infection (SBI), often followed by admission and empirical antibiotics. As febrile children with a viral infection are less likely to have a SBI, identifying patients with systemic viral infection could contribute to exclude SBI. We evaluated whether the presence of virus in the blood could be used as a biomarker to rule out SBI. Children < 3 years old with FWS were prospectively enrolled and had real-time (reverse-transcription) PCR performed on the blood for adenovirus, enterovirus, parechovirus, and HHV6. 20/135 patients had SBI, and in 47/135, at least one virus was detected in the blood. Viremia had a higher sensitivity and negative predictive value (90% and 96%) to rule out SBI compared to CRP (65% and 93%) and PCT (55% and 90%). The odds ratio (OR) for the presence of SBI among non-viremic patients was 5.8 (p = 0.0225), compared to 5.5 for CRP ≥ 40 mg/l (p = 0.0009) and 3.7 for PCT ≥ 0.5 ng/mL (0.0093). This remained significant after adjusting for CRP and PCT (OR 5.6 and 5.9, respectively; p = 0.03 for both). Area under the ROC curve for CRP and PCT were 0.754 and 0.779, respectively, but increased to 0.803 and 0.832, respectively, when combined with viremia. CONCLUSION The presence of viremia had a better performance than commonly used biomarkers to rule-out SBI and could potentially be used in conjunction with CRP and/or PCT in the evaluation of children with FWS. Larger studies should evaluate the role of point-of-care testing of viruses by (revere-transcription) PCR in the plasma in management algorithms of children with FWS. WHAT IS KNOWN • Most children with FWS have a viral infection, but up to 15% have a SBI; most require laboratory tests, and many admission and empirical antibiotics. • Children with a viral infection are less likely to have a SBI. WHAT IS NEW • Children with a systemic viral infection are less likely to have an SBI. • Viremia is a better predictor of absence of SBI than commonly used biomarkers and could potentially be used in conjunction with CRP and/or PCT in the evaluation of children with FWS.
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Affiliation(s)
- Annick Galetto-Lacour
- grid.150338.c0000 0001 0721 9812Division of Pediatric Emergencies, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Samuel Cordey
- grid.150338.c0000 0001 0721 9812Laboratory of Virology, Diagnostics Department, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Sebastien Papis
- grid.150338.c0000 0001 0721 9812Division of General Pediatrics, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Chiara Mardegan
- grid.150338.c0000 0001 0721 9812Division of General Pediatrics, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Fanny Luterbacher
- grid.150338.c0000 0001 0721 9812Division of General Pediatrics, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Christophe Combescure
- grid.150338.c0000 0001 0721 9812Division of Clinical Epidemiology, Department of Health and Community Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Laurence Lacroix
- grid.150338.c0000 0001 0721 9812Division of Pediatric Emergencies, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Alain Gervaix
- grid.150338.c0000 0001 0721 9812Division of Pediatric Emergencies, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Laurent Kaiser
- grid.150338.c0000 0001 0721 9812Laboratory of Virology, Diagnostics Department, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland ,grid.150338.c0000 0001 0721 9812Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Klara M. Posfay-Barbe
- grid.150338.c0000 0001 0721 9812Division of General Pediatrics, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland ,grid.150338.c0000 0001 0721 9812Pediatric Infectious Diseases Unit, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Arnaud G. L’Huillier
- grid.150338.c0000 0001 0721 9812Laboratory of Virology, Diagnostics Department, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland ,grid.150338.c0000 0001 0721 9812Division of General Pediatrics, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland ,grid.150338.c0000 0001 0721 9812Pediatric Infectious Diseases Unit, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Mukherjee G, Waris R, Rechler W, Kudelka M, McCracken C, Kirpalani A, Hames N. Determining Normative Values for Cerebrospinal Fluid Profiles in Infants. Hosp Pediatr 2021; 11:930-936. [PMID: 34344692 DOI: 10.1542/hpeds.2020-005512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previous studies of reference values for cerebrospinal fluid (CSF) profiles have been limited by small sample size and few exclusion criteria. OBJECTIVE To determine age-specific normative CSF white blood cell count (WBC), glucose, and protein values in infants ≤90 days old. METHODS Performed a retrospective cross-sectional study of infants ≤90 days old who had a diagnostic lumbar puncture between 2008 and 2016. Infants with bacterial meningitis, bacteremia, UTI, positive CSF herpes simplex virus polymerase chain reaction (PCR) result, traumatic lumbar puncture, ventriculoperitoneal shunt, prematurity, recent seizure, previous antibiotic use, and history of a complex chronic condition were excluded for calculations to determine normative values. Data on demographics and CSF values (WBC with differential, protein, glucose, enterovirus PCR) were collected. CSF values were compared by age and by enterovirus PCR results using Kruskal-Wallis and Wilcoxon rank tests. RESULTS A total of 1029 out of 2000 patients were included and divided into 3 age groups: 0 to 28 days, 29 to 60 days, 61 to 90 days. CSF WBC values were significantly greater for 0- to 28-day old infants (median: 3, 95th percentile: 14) than for 29- to 60-day and 61- to 90-day old infants (median: 2 and 2; 95th percentile: 7 and 11, respectively) (P < .001). With each month of life, the median CSF protein significantly decreased and glucose significantly increased. In the CSF WBC differential, monocytes were found to be prevalent. CONCLUSION We determined age-specific normative components for CSF profile values for infants 0 to 90 days.
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Affiliation(s)
- Gargi Mukherjee
- Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | | | - Willi Rechler
- UCLA Mattel Children's Hospital, Los Angeles, California
| | | | | | - Anjali Kirpalani
- Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Nicole Hames
- Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
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L'Huillier AG, Mardegan C, Cordey S, Luterbacher F, Papis S, Hugon F, Kaiser L, Gervaix A, Posfay-Barbe K, Galetto-Lacour A. Enterovirus, parechovirus, adenovirus and herpes virus type 6 viraemia in fever without source. Arch Dis Child 2020; 105:180-186. [PMID: 31462437 DOI: 10.1136/archdischild-2019-317382] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/29/2019] [Accepted: 08/07/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the potential associations between fever without a source (FWS) in children and detection of human enterovirus (HEV), human parechovirus (HPeV), adenovirus (AdV) and human herpesvirus type 6 (HHV-6) in the plasma; and to assess whether the detection of viruses in the plasma is associated with a reduced risk of serious bacterial infection (SBI) and antibiotic use. DESIGN AND SETTING Between November 2015 and December 2017, this prospective, single-centre, diagnostic study tested the plasma of children <3 years old with FWS. Real-time (reverse-transcription) PCR for HEV, HPeV, AdV and HHV-6 was used in addition to the standardised institutional work-up. A control cohort was also tested for the presence of viruses in their blood. RESULTS HEV, HPeV, AdV and HHV-6 were tested for in the plasma of 135 patients of median age 2.4 months old. At least one virus was detected in 47 of 135 (34.8%): HEV in 14.1%, HHV-6 in 11.1%, HPeV in 5.9% and AdV in 5.2%. There was no difference in antibiotic use between patients with or without virus detected, despite a relative risk of 0.2 for an SBI among patients with viraemia. Controls were less frequently viraemic than children with FWS (6.0% vs 34.8%; p<0.001). CONCLUSIONS HEV, HPeV, AdV and HHV-6 are frequently detected in the plasma of children with FWS. Antibiotic use was similar between viraemic and non-viraemic patients despite a lower risk of SBI among patients with viraemia. Point-of-care viral PCR testing of plasma might reduce antibiotic use and possibly investigations and admission rates in patients with FWS. TRIAL REGISTRATION NUMBER NCT03224026.
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Affiliation(s)
- Arnaud Gregoire L'Huillier
- Pediatric Infectious Diseases Unit, Department of Child and Adolescent Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland .,Division of Infectious Diseases and Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Chiara Mardegan
- Division of General Pediatrics, Department of Child and Adolescent Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Samuel Cordey
- Division of Infectious Diseases and Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Fanny Luterbacher
- Division of Pediatric Emergencies, Department of Child and Adolescent Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Sebastien Papis
- Division of General Pediatrics, Department of Child and Adolescent Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Florence Hugon
- Division of Pediatric Emergencies, Department of Child and Adolescent Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Laurent Kaiser
- Division of Infectious Diseases and Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Alain Gervaix
- Division of Pediatric Emergencies, Department of Child and Adolescent Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Klara Posfay-Barbe
- Pediatric Infectious Diseases Unit, Department of Child and Adolescent Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland.,Division of Infectious Diseases and Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Annick Galetto-Lacour
- Division of Pediatric Emergencies, Department of Child and Adolescent Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland
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Epalza C, Hallin M, Busson L, Debulpaep S, De Backer P, Vandenberg O, Levy J. Role of Viral Molecular Panels in Diagnosing the Etiology of Fever in Infants Younger Than 3 Months. Clin Pediatr (Phila) 2020; 59:45-52. [PMID: 31709801 PMCID: PMC7206330 DOI: 10.1177/0009922819884582] [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: 11/16/2022]
Abstract
As infants with proven viral infection present lower risk of bacterial infection, we evaluated how molecular methods detecting viruses on respiratory secretions could contribute to etiological diagnostic of these febrile episodes. From November 2010 to May 2011, we enrolled all febrile infants <90 days presenting to emergency room. Standard workup included viral rapid antigenic test and viral culture on nasopharyngeal aspirate. Samples negative by rapid testing were tested by molecular methods. From 208 febrile episodes (198 infants) with standard techniques, rate of documented microbiological etiology was 13% at emergency department, 47% during hospitalization, and 64% with viral cultures. Molecular methods increased microbiologically documented etiology rate by 12%, to 76%. Contribution of molecular methods was the highest in infants without clinical source of infection, increasing documentation by 18%, from 50% to 68%. Making viral molecular results rapidly available could help identifying a higher proportion of infants at low risk of serious bacterial infection.
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Affiliation(s)
- Cristina Epalza
- Saint Pierre University Hospital, Bruxelles, Belgium,Université Libre de Bruxelles, Bruxelles, Belgium,Cristina Epalza, Pediatric Department, Saint Pierre University Hospital, Université Libre de Bruxelles, Bruxelles, Belgium.
| | - Marie Hallin
- Saint Pierre University Hospital, Bruxelles, Belgium,Université Libre de Bruxelles, Bruxelles, Belgium
| | - Laurent Busson
- Saint Pierre University Hospital, Bruxelles, Belgium,Université Libre de Bruxelles, Bruxelles, Belgium
| | - Sara Debulpaep
- Saint Pierre University Hospital, Bruxelles, Belgium,Université Libre de Bruxelles, Bruxelles, Belgium
| | - Paulette De Backer
- Saint Pierre University Hospital, Bruxelles, Belgium,Université Libre de Bruxelles, Bruxelles, Belgium
| | - Olivier Vandenberg
- Saint Pierre University Hospital, Bruxelles, Belgium,Université Libre de Bruxelles, Bruxelles, Belgium
| | - Jack Levy
- Saint Pierre University Hospital, Bruxelles, Belgium,Université Libre de Bruxelles, Bruxelles, Belgium
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Belov Y, Leibovitz E, Vodonos A, Hazan G, Ling E, Melamed R. Performance of risk stratification criteria in the management of febrile young infants younger than three months of age. Acta Paediatr 2018; 107:496-503. [PMID: 29080319 DOI: 10.1111/apa.14134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 10/24/2017] [Indexed: 11/29/2022]
Abstract
AIM We evaluated the diagnosis, risk stratification and management of febrile infants under three months of age who presented to an Israeli paediatric emergency room (ER). METHODS This retrospective study enrolled all febrile infants examined in the paediatric ER of Soroka Medical Center during 2010-2013. The patients were classified into low-risk and high-risk subgroups and compared by age and ethnicity. RESULTS Overall, 2251 febrile infants (60.5% of Bedouin and 34.4% of Jewish ethnicity) were enrolled. Hospitalisation rates were higher among Bedouin vs. Jewish infants (55 vs. 39.8%, p < 0.001). Fever without localising signs was diagnosed in 1028 (45.6%) infants and 499 (48.5%) were hospitalised; 26% were stratified as high-risk and 74% as low-risk. Bedouin infants rates were more likely to be at high-risk (p = 0.001) and hospitalised (p < 0.001) than Jewish infants. With regard to low-risk infants, the incidence rates were higher before two months than two to three months of age (73.3 vs. 59%, p < 0.001), as were the hospitalisation rates (46.3 vs. 20.1%, p < 0.001). No differences were recorded for the hospitalisation rates of Bedouin and Jewish infants between the three daily shifts. CONCLUSION Major differences were recorded in hospitalisation rates, risk stratification and management of Bedouin and Jewish infants with fever without localising signs.
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Affiliation(s)
- Yekaterina Belov
- Pediatric Infectious Disease Unit; Faculty of Health Sciences; Soroka University Medical Center; Ben-Gurion University of the Negev; Beer-Sheva Israel
| | - Eugene Leibovitz
- Pediatric Infectious Disease Unit; Faculty of Health Sciences; Soroka University Medical Center; Ben-Gurion University of the Negev; Beer-Sheva Israel
- Pediatric Division; Faculty of Health Sciences; Soroka University Medical Center; Ben-Gurion University of the Negev; Beer-Sheva Israel
| | - Alina Vodonos
- Center for Clinical Research; Faculty of Health Sciences; Soroka University Medical Center; Ben-Gurion University of the Negev; Beer-Sheva Israel
| | - Guy Hazan
- Pediatric Infectious Disease Unit; Faculty of Health Sciences; Soroka University Medical Center; Ben-Gurion University of the Negev; Beer-Sheva Israel
| | - Eduard Ling
- Pediatric Division; Faculty of Health Sciences; Soroka University Medical Center; Ben-Gurion University of the Negev; Beer-Sheva Israel
| | - Rimma Melamed
- Pediatric Infectious Disease Unit; Faculty of Health Sciences; Soroka University Medical Center; Ben-Gurion University of the Negev; Beer-Sheva Israel
- Pediatric Division; Faculty of Health Sciences; Soroka University Medical Center; Ben-Gurion University of the Negev; Beer-Sheva Israel
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7
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Forrest AJ, Juliano ML, Conley SP, Cronyn PD, McGlynn A, Auten JD. Temporal artery and axillary thermometry comparison with rectal thermometry in children presenting to the ED. Am J Emerg Med 2017. [DOI: 10.1016/j.ajem.2017.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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8
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Vlcek C, Rack-Hoch A, von Both U, Jansson A. [Fever in infants: investigating the source]. MMW Fortschr Med 2016; 158:58-66. [PMID: 27646382 DOI: 10.1007/s15006-016-8229-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Christine Vlcek
- Dr. von Haunersches Kinderspital, Klinikum der Universität München, Lindwurmstr. 4, D-80337, München, Deutschland.
| | - Anita Rack-Hoch
- Dr. von Haunersches Kinderspital, Klinikum der Universität München, Lindwurmstr. 4, D-80337, München, Deutschland
| | - Ulrich von Both
- Dr. von Haunersches Kinderspital, Klinikum der Universität München, Lindwurmstr. 4, D-80337, München, Deutschland
| | - Annette Jansson
- Dr. von Haunersches Kinderspital, Klinikum der Universität München, Lindwurmstr. 4, D-80337, München, Deutschland
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Gomez B, Mintegi S, Bressan S, Da Dalt L, Gervaix A, Lacroix L. Validation of the "Step-by-Step" Approach in the Management of Young Febrile Infants. Pediatrics 2016; 138:peds.2015-4381. [PMID: 27382134 DOI: 10.1542/peds.2015-4381] [Citation(s) in RCA: 212] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A sequential approach to young febrile infants on the basis of clinical and laboratory parameters, including procalcitonin, was recently described as an accurate tool in identifying patients at risk for invasive bacterial infection (IBI). Our aim was to prospectively validate the Step-by-Step approach and compare it with the Rochester criteria and the Lab-score. METHODS Prospective study including infants ≤90 days with fever without source presenting in 11 European pediatric emergency departments between September 2012 and August 2014. The accuracy of the Step-by-Step approach, the Rochester criteria, and the Lab-score in identifying patients at low risk of IBI (isolation of a bacterial pathogen in a blood or cerebrospinal fluid culture) was compared. RESULTS Eighty-seven of 2185 infants (4.0%) were diagnosed with an IBI. The prevalence of IBI was significantly higher in infants classified as high risk or intermediate risk according to the Step by Step than in low risk patients. Sensitivity and negative predictive value for ruling out an IBI were 92.0% and 99.3% for the Step by Step, 81.6% and 98.3% for the Rochester criteria, and 59.8% and 98.1% for the Lab-score. Seven infants with an IBI were misclassified by the Step by Step, 16 by Rochester criteria, and 35 by the Lab-score. CONCLUSIONS We validated the Step by Step as a valuable tool for the management of infants with fever without source in the emergency department and confirmed its superior accuracy in identifying patients at low risk of IBI, compared with the Rochester criteria and the Lab-score.
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Affiliation(s)
- Borja Gomez
- Pediatric Emergency Department, Cruces University Hospital, Bilbao, Spain; University of the Basque Country, Bilbao, Spain;
| | - Santiago Mintegi
- Pediatric Emergency Department, Cruces University Hospital, Bilbao, Spain; University of the Basque Country, Bilbao, Spain
| | - Silvia Bressan
- Pediatric Emergency Unit - Department of Woman's and Child Health, University of Padova, Italy
| | | | - Alain Gervaix
- Pediatric Emergency Division, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Laurence Lacroix
- Pediatric Emergency Division, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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Hernández-Bou S, Álvarez Álvarez C, Campo Fernández M, García Herrero M, Gené Giralt A, Giménez Pérez M, Piñeiro Pérez R, Gómez Cortés B, Velasco R, Menasalvas Ruiz A, García García J, Rodrigo Gonzalo de Liria C. Blood cultures in the paediatric emergency department. Guidelines and recommendations on their indications, collection, processing and interpretation. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.anpede.2015.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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11
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Abstract
We reviewed the literature regarding bacteremia in early infancy (age ≤ 90 days). Bacteremia remains a major cause of morbidity and mortality in young infants. However, recent epidemiologic data suggest that the incidence of bacteremia is decreasing and the pathogens responsible for invasive disease are changing. These changes will impact the evaluation and management of young infants. We review the current epidemiology of community-acquired bacteremia in early infancy with particular emphasis on the causative agents, diagnostic evaluation, and empiric and definitive antimicrobial treatment.
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12
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Hernández-Bou S, Álvarez Álvarez C, Campo Fernández MN, García Herrero MA, Gené Giralt A, Giménez Pérez M, Piñeiro Pérez R, Gómez Cortés B, Velasco R, Menasalvas Ruiz AI, García García JJ, Rodrigo Gonzalo de Liria C. [Blood cultures in the paediatric emergency department. Guidelines and recommendations on their indications, collection, processing and interpretation]. An Pediatr (Barc) 2015; 84:294.e1-9. [PMID: 26227314 DOI: 10.1016/j.anpedi.2015.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 06/17/2015] [Indexed: 12/11/2022] Open
Abstract
Blood culture (BC) is the gold standard when a bacteraemia is suspected, and is one of the most requested microbiological tests in paediatrics. Some changes have occurred in recent years: the introduction of new vaccines, the increasing number of patients with central vascular catheters, as well as the introduction of continuous monitoring BC systems. These changes have led to the review and update of different factors related to this technique in order to optimise its use. A practice guideline is presented with recommendations on BC, established by the Spanish Society of Paediatric Emergency Care and the Spanish Society for Paediatric Infectious Diseases. After reviewing the available scientific evidence, several recommendations for each of the following aspects are presented: BC indications in the Emergency Department, how to obtain, transport and process cultures, special situations (indications and interpretation of results in immunosuppressed patients and/or central vascular catheter carriers, indications for anaerobic BC), differentiation between bacteraemia and contamination when a BC shows bacterial growth and actions to take with a positive BC in patients with fever of unknown origin.
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Affiliation(s)
- S Hernández-Bou
- Grupo para el estudio de la bacteriemia, Grupo de Trabajo de Enfermedades Infecciosas de la Sociedad Española de Urgencias de Pediatría (SEUP), Sociedad Española de Urgencias de Pediatría (SEUP).
| | | | - M N Campo Fernández
- Grupo para el estudio de la bacteriemia, Grupo de Trabajo de Enfermedades Infecciosas de la Sociedad Española de Urgencias de Pediatría (SEUP), Sociedad Española de Urgencias de Pediatría (SEUP)
| | - M A García Herrero
- Grupo para el estudio de la bacteriemia, Grupo de Trabajo de Enfermedades Infecciosas de la Sociedad Española de Urgencias de Pediatría (SEUP), Sociedad Española de Urgencias de Pediatría (SEUP)
| | - A Gené Giralt
- Servicio de Microbiología, Hospital Sant Joan de Déu, Barcelona, España
| | - M Giménez Pérez
- Servicio de Microbiología, Hospital Universitari Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona, Barcelona, España
| | | | - B Gómez Cortés
- Grupo para el estudio de la bacteriemia, Grupo de Trabajo de Enfermedades Infecciosas de la Sociedad Española de Urgencias de Pediatría (SEUP), Sociedad Española de Urgencias de Pediatría (SEUP)
| | - R Velasco
- Grupo para el estudio de la bacteriemia, Grupo de Trabajo de Enfermedades Infecciosas de la Sociedad Española de Urgencias de Pediatría (SEUP), Sociedad Española de Urgencias de Pediatría (SEUP)
| | | | - J J García García
- Grupo para el estudio de la bacteriemia, Grupo de Trabajo de Enfermedades Infecciosas de la Sociedad Española de Urgencias de Pediatría (SEUP), Sociedad Española de Urgencias de Pediatría (SEUP)
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