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Be'er M, Rimon A, Segev O, Huber A, Scolnik D, Glatstein M. Incidence of Bacteremia and Serious Bacterial Infections in Hyperpyrexic Infants Offered Universal Pneumococcal Conjugate Vaccine 13 and Haemophilus influenzae B Immunization. Pediatr Emerg Care 2024:00006565-990000000-00473. [PMID: 38776442 DOI: 10.1097/pec.0000000000003217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND High fevers, especially in young children, often alarm clinicians and prompt extensive evaluation based on perceptions of increased risk of serious bacterial infection (SBI), and even brain damage or seizure disorders. OBJECTIVE The aim of this study was to determine the prevalence of SBI in infants aged 3-36 months with fever ≥40.5°C in a population of infants offered universal pneumococcal conjugate vaccine 13 and Haemophilus influenzae B immunization. METHODS This study is a retrospective review of all infants aged 3-36 months with temperature ≥40.5°C presenting to a tertiary care pediatric emergency department over a 30-month period in an era of universal pneumococcal conjugate 13 and H. influenzae B immunization. RESULTS SBI was recorded in 54 (21.8%) of 247 study infants, most commonly pneumonia 30 patients (12.1%) and urinary tract infection 16 patients (6.5%). Two patients had positive blood cultures, yielding a bacteremia rate of 0.8%. Patients with SBI had a significantly higher WBC count (P < 0.0001) and C-reactive protein levels (P < 0.0001), and were significantly more likely to be hospitalized (P < 0.0001). DISCUSSION Although SBI was common (21.8%) in our cohort of hyperpyrexic infants universally offered vaccination with pneumococcal conjugate 13 and H. influenzae B vaccines, bacteremia was a rare finding (0.8%).
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Affiliation(s)
- Moria Be'er
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, Dana-Dwek Children Hospital
| | - Ayelet Rimon
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, Dana-Dwek Children Hospital
| | - Or Segev
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, Dana-Dwek Children Hospital
| | - Adi Huber
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, Dana-Dwek Children Hospital
| | - Dennis Scolnik
- Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Miguel Glatstein
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, Dana-Dwek Children Hospital
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Dungu KHS, Carlsen ELM, Glenthøj JP, Schmidt LS, Jørgensen IM, Cortes D, Poulsen A, Vissing NH, Bagger FO, Nygaard U. Host RNA Expression Signatures in Young Infants with Urinary Tract Infection: A Prospective Study. Int J Mol Sci 2024; 25:4857. [PMID: 38732074 PMCID: PMC11084417 DOI: 10.3390/ijms25094857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/16/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
Early diagnosis of infections in young infants remains a clinical challenge. Young infants are particularly vulnerable to infection, and it is often difficult to clinically distinguish between bacterial and viral infections. Urinary tract infection (UTI) is the most common bacterial infection in young infants, and the incidence of associated bacteremia has decreased in the recent decades. Host RNA expression signatures have shown great promise for distinguishing bacterial from viral infections in young infants. This prospective study included 121 young infants admitted to four pediatric emergency care departments in the capital region of Denmark due to symptoms of infection. We collected whole blood samples and performed differential gene expression analysis. Further, we tested the classification performance of a two-gene host RNA expression signature approaching clinical implementation. Several genes were differentially expressed between young infants with UTI without bacteremia and viral infection. However, limited immunological response was detected in UTI without bacteremia compared to a more pronounced response in viral infection. The performance of the two-gene signature was limited, especially in cases of UTI without bloodstream involvement. Our results indicate a need for further investigation and consideration of UTI in young infants before implementing host RNA expression signatures in clinical practice.
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Affiliation(s)
- Kia Hee Schultz Dungu
- Department of Pediatrics & Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (K.H.S.D.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Emma Louise Malchau Carlsen
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Jonathan Peter Glenthøj
- Department of Pediatrics & Adolescent Medicine, Copenhagen University Hospital North Zealand, 3400 Hillerød, Denmark
| | - Lisbeth Samsø Schmidt
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Pediatrics & Adolescent Medicine, Copenhagen University Hospital Herlev, 2730 Herlev, Denmark
| | - Inger Merete Jørgensen
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Pediatrics & Adolescent Medicine, Copenhagen University Hospital North Zealand, 3400 Hillerød, Denmark
| | - Dina Cortes
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Pediatrics & Adolescent Medicine, Copenhagen University Hospital Hvidovre, 2650 Hvidovre, Denmark
| | - Anja Poulsen
- Department of Pediatrics & Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (K.H.S.D.)
| | - Nadja Hawwa Vissing
- Department of Pediatrics & Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (K.H.S.D.)
| | - Frederik Otzen Bagger
- Center for Genomic Medicine, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Ulrikka Nygaard
- Department of Pediatrics & Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (K.H.S.D.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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Ballard DW, Huang J, Sharp AL, Mark DG, Nguyen THP, Young BR, Vinson DR, Van Winkle P, Kene MV, Rauchwerger AS, Zhang JY, Park SJ, Reed ME, Greenhow TL. An all-inclusive model for predicting invasive bacterial infection in febrile infants age 7-60 days. Pediatr Res 2024:10.1038/s41390-024-03141-3. [PMID: 38575694 DOI: 10.1038/s41390-024-03141-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Invasive bacterial infections (IBIs) in febrile infants are rare but potentially devastating. We aimed to derive and validate a predictive model for IBI among febrile infants age 7-60 days. METHODS Data were abstracted retrospectively from electronic records of 37 emergency departments (EDs) for infants with a measured temperature >=100.4 F who underwent an ED evaluation with blood and urine cultures. Models to predict IBI were developed and validated respectively using a random 80/20 dataset split, including 10-fold cross-validation. We used precision recall curves as the classification metric. RESULTS Of 4411 eligible infants with a mean age of 37 days, 29% had characteristics that would likely have excluded them from existing risk stratification protocols. There were 196 patients with IBI (4.4%), including 43 (1.0%) with bacterial meningitis. Analytic approaches varied in performance characteristics (precision recall range 0.04-0.29, area under the curve range 0.5-0.84), with the XGBoost model demonstrating the best performance (0.29, 0.84). The five most important variables were serum white blood count, maximum temperature, absolute neutrophil count, absolute band count, and age in days. CONCLUSION A machine learning model (XGBoost) demonstrated the best performance in predicting a rare outcome among febrile infants, including those excluded from existing algorithms. IMPACT Several models for the risk stratification of febrile infants have been developed. There is a need for a preferred comprehensive model free from limitations and algorithm exclusions that accurately predicts IBIs. This is the first study to derive an all-inclusive predictive model for febrile infants aged 7-60 days in a community ED sample with IBI as a primary outcome. This machine learning model demonstrates potential for clinical utility in predicting IBI.
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Affiliation(s)
- Dustin W Ballard
- The Permanente Medical Group, Oakland, CA, USA.
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
| | - Jie Huang
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Adam L Sharp
- Kaiser Permanente Bernard J. Tyson School of Medicine, Health Systems Science Department, Pasadena, CA, USA
| | - Dustin G Mark
- The Permanente Medical Group, Oakland, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Tran H P Nguyen
- Department of Hospital Pediatrics, Kaiser Permanente Northern California, Roseville, CA, USA
| | - Beverly R Young
- Department of Hospital Pediatrics, Kaiser Permanente Northern California, Roseville, CA, USA
| | - David R Vinson
- The Permanente Medical Group, Oakland, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Patrick Van Winkle
- Department of Pediatrics, Kaiser Permanente Southern California, Anaheim, CA, USA
| | | | - Adina S Rauchwerger
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Jennifer Y Zhang
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Stacy J Park
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Mary E Reed
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Tara L Greenhow
- The Permanente Medical Group, Oakland, CA, USA
- Division of Infectious Diseases, Department of Pediatrics, Kaiser Permanente Northern California, San Francisco, CA, USA
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Mace AO, Totterdell J, Martin AC, Ramsay J, Barnett J, Ferullo J, Hazelton B, Ingram P, Marsh JA, Wu Y, Richmond P, Snelling TL. FeBRILe3: Safety Evaluation of Febrile Infant Guidelines Through Prospective Bayesian Monitoring. Hosp Pediatr 2023; 13:865-875. [PMID: 37609781 DOI: 10.1542/hpeds.2023-007160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
OBJECTIVES Despite evidence supporting earlier discharge of well-appearing febrile infants at low risk of serious bacterial infection (SBI), admissions for ≥48 hours remain common. Prospective safety monitoring may support broader guideline implementation. METHODS A sequential Bayesian safety monitoring framework was used to evaluate a new hospital guideline recommending early discharge of low-risk infants. Hospital readmissions within 7 days of discharge were regularly assessed against safety thresholds, derived from historic rates and expert opinion, and specified a priori (8 per 100 infants). Infants aged under 3 months admitted to 2 Western Australian metropolitan hospitals for management of fever without source were enrolled (August 2019-December 2021), to a prespecified maximum 500 enrolments. RESULTS Readmission rates remained below the prespecified threshold at all scheduled analyses. Median corrected age was 34 days, and 14% met low-risk criteria (n = 71). SBI was diagnosed in 159 infants (32%), including urinary tract infection (n = 140) and bacteraemia (n = 18). Discharge occurred before 48 hours for 192 infants (38%), including 52% deemed low-risk. At study completion, 1 of 37 low-risk infants discharged before 48 hours had been readmitted (3%), for issues unrelated to SBI diagnosis. In total, 20 readmissions were identified (4 per 100 infants; 95% credible interval 3, 6), with >0.99 posterior probability of being below the prespecified noninferiority threshold, indicating acceptable safety. CONCLUSIONS A Bayesian monitoring approach supported safe early discharge for many infants, without increased risk of readmission. This framework may be used to embed safety evaluations within future guideline implementation programs to further reduce low-value care.
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Affiliation(s)
- Ariel O Mace
- Departments of General Paediatrics
- Department of Paediatrics, Fiona Stanley Hospital, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute
| | - James Totterdell
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Jessica Ramsay
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute
| | | | - Jade Ferullo
- Department of Paediatrics, Fiona Stanley Hospital, Western Australia, Australia
| | - Briony Hazelton
- Infectious Diseases, Perth Children's Hospital, Western Australia, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Western Australia, Australia
| | - Paul Ingram
- Pathology and Laboratory Medicine
- Department of Microbiology, PathWest Laboratory Medicine, Western Australia, Australia
| | - Julie A Marsh
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute
- Centre for Child Health Research, The University of Western Australia, Western Australia, Australia
| | - Yue Wu
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter Richmond
- Departments of General Paediatrics
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute
- Schools of Medicine
| | - Thomas L Snelling
- Infectious Diseases, Perth Children's Hospital, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Menzies School of Health Research, Charles Darwin University, Northern Territory, Australia
- Curtin University, Western Australia, Australia
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Liang R, Chen Z, Yang S, Yang J, Wang Z, Lin X, Xu F. A diagnostic model based on routine blood examination for serious bacterial infections in neonates-a cross-sectional study. Epidemiol Infect 2023; 151:e137. [PMID: 37519228 PMCID: PMC10540195 DOI: 10.1017/s0950268823001231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/26/2023] [Accepted: 07/21/2023] [Indexed: 08/01/2023] Open
Abstract
Routine blood examination is an easy way to examine infectious diseases. This study is aimed to develop a model to diagnose serious bacterial infections (SBI) in ICU neonates based on routine blood parameters. This was a cross-sectional study, and data were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III). SBI was defined as suffering from one of the following: pyelonephritis, bacteraemia, bacterial meningitis, sepsis, pneumonia, cellulitis, and osteomyelitis. Variables with statistical significance in the univariate logistic regression analysis and log systemic immune-inflammatory index (SII) were used to develop the model. The area under the curve (AUC) was calculated to assess the performance of the model. A total of 1,880 participants were finally included for analysis. Weight, haemoglobin, mean corpuscular volume, white blood cell, monocyte, premature delivery, and log SII were selected to develop the model. The developed model showed a good performance to diagnose SBI for ICU neonates, with an AUC of 0.812 (95% confidence interval (CI): 0.737-0.888). A nomogram was developed to make this model visualise. In conclusion, our model based on routine blood parameters performed well in the diagnosis of neonatal SBI, which may be helpful for clinicians to improve treatment recommendations.
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Affiliation(s)
- Runqiang Liang
- National Key Clinical Specialty Construction Project/Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
- Guangdong Neonatal ICU Medical Quality Control Center, Guangzhou, China
| | - Ziyu Chen
- Department of Respiratory Medicine, Foshan Sanshui District People’s Hospital, Foshan, China
| | - Shumei Yang
- National Key Clinical Specialty Construction Project/Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
- Guangdong Neonatal ICU Medical Quality Control Center, Guangzhou, China
| | - Jie Yang
- National Key Clinical Specialty Construction Project/Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
- Guangdong Neonatal ICU Medical Quality Control Center, Guangzhou, China
| | - Zhu Wang
- National Key Clinical Specialty Construction Project/Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
- Guangdong Neonatal ICU Medical Quality Control Center, Guangzhou, China
| | - Xin Lin
- Guangdong Neonatal ICU Medical Quality Control Center, Guangzhou, China
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, China
| | - Fang Xu
- National Key Clinical Specialty Construction Project/Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
- Guangdong Neonatal ICU Medical Quality Control Center, Guangzhou, China
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Flannery DD, Edwards EM, Coggins SA, Horbar JD, Puopolo KM. Late-Onset Sepsis Among Very Preterm Infants. Pediatrics 2022; 150:e2022058813. [PMID: 36366916 PMCID: PMC11151779 DOI: 10.1542/peds.2022-058813] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To determine the epidemiology, microbiology, and associated outcomes of late-onset sepsis among very preterm infants using a large and nationally representative cohort of NICUs across the United States. METHODS Prospective observational study of very preterm infants born 401 to 1500 g and/or 22 to 29 weeks' gestational age (GA) from January 1, 2018, to December 31, 2020, who survived >3 days in 774 participating Vermont Oxford Network centers. Late-onset sepsis was defined as isolation of a pathogenic bacteria from blood and/or cerebrospinal fluid, or fungi from blood, obtained >3 days after birth. Demographics, clinical characteristics, and outcomes were compared between infants with and without late-onset sepsis. RESULTS Of 118 650 infants, 10 501 (8.9%) had late-onset sepsis for an incidence rate of 88.5 per 1000 (99% confidence interval [CI] [86.4-90.7]). Incidence was highest for infants born ≤23 weeks GA (322.0 per 1000, 99% CI [306.3-338.1]). The most common pathogens were coagulase negative staphylococci (29.3%) and Staphylococcus aureus (23.0%), but 34 different pathogens were identified. Infected infants had lower survival (adjusted risk ratio [aRR] 0.89, 95% CI [0.87-0.90]) and increased risks of home oxygen (aRR 1.32, 95% CI [1.26-1.38]), tracheostomy (aRR 2.88, 95% CI [2.47-3.37]), and gastrostomy (aRR 2.09, 95% CI [1.93-2.57]) among survivors. CONCLUSIONS A substantial proportion of very preterm infants continue to suffer late-onset sepsis, particularly those born at the lowest GAs. Infected infants had higher mortality, and survivors had increased risks of technology-dependent chronic morbidities. The persistent burden and diverse microbiology of late-onset sepsis among very preterm infants underscore the need for innovative and potentially organism-specific prevention strategies.
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Affiliation(s)
- Dustin D. Flannery
- Division of Neonatology
- Clinical Futures, Children’s Hospital of Philadelphia; Philadelphia, Pennsylvania
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Erika M. Edwards
- Larner College of Medicine
- College of Engineering and Mathematical Sciences at the University of Vermont, Burlington, Vermont
- Vermont Oxford Network, Burlington, Vermont
| | - Sarah A. Coggins
- Division of Neonatology
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jeffrey D. Horbar
- Larner College of Medicine
- Vermont Oxford Network, Burlington, Vermont
| | - Karen M. Puopolo
- Division of Neonatology
- Clinical Futures, Children’s Hospital of Philadelphia; Philadelphia, Pennsylvania
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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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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Barreiro-Parrado A, Lopez E, Gomez B, Lejarzegi A, Fernandez-Uria A, Benito J, Mintegi S. Rate of invasive bacterial infection in recently vaccinated young infants with fever without source. Arch Dis Child 2022; 107:archdischild-2022-324379. [PMID: 35896416 DOI: 10.1136/archdischild-2022-324379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/15/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare the rates of invasive bacterial infection (IBI) (bacterial pathogen in blood or cerebrospinal fluid) and urinary tract infection (UTI) in febrile infants between 42 and 90 days of age who had and had not been vaccinated in the previous 48 hours. DESIGN Observational study; secondary analysis of a prospective registry-based cohort study. SETTING Paediatric emergency department. PATIENTS Infants 42-90 days of age with fever without source seen between 2010 and 2021. MAIN OUTCOME MEASURES Rates of IBI (bacterial pathogen in blood or cerebrospinal fluid) and UTI (urine culture obtained by an aseptic method yielding growth of ≥10 000 cfu/mL with associated leucocyturia). RESULTS We included 1522 infants, including 185 (12.2%) vaccinated in the previous 48 hours. Overall, 19 (1.25%) were diagnosed with an IBI and 282 (18.5%) with a UTI. No recently immunised infants were diagnosed with an IBI (vs 19, 1.4% of those not recently immunised, p=0.2). The UTI rate was higher in infants not recently immunised (20.1% vs 7.0%, p<0.01; OR: 3.3 (1.9-5.9)). CONCLUSIONS Although the rate of UTI in recently immunised infants 42-90 days old with fever without a source is lower than in those not recently immunised, recommending screening for UTI seems appropriate. If the lower rate of IBI among recently immunised well-appearing infants is confirmed, the recommendation to systematically perform blood tests in these infants should be reconsidered.
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Affiliation(s)
- Ana Barreiro-Parrado
- Pediatric Emergency Department, Hospital Universitario Cruces Urgencias de Pediatria, Barakaldo, Spain
| | - Eider Lopez
- Pediatric Emergency Department, Hospital Universitario Cruces Urgencias de Pediatria, Barakaldo, Spain
| | - Borja Gomez
- Pediatric Emergency Department, Hospital Universitario Cruces Urgencias de Pediatria, Barakaldo, Spain
- Department of Pediatrics, Universidad del Pais Vasco, Bilbao, Basque Country, Spain
| | - Ainara Lejarzegi
- Pediatric Emergency Department, Hospital Universitario Cruces Urgencias de Pediatria, Barakaldo, Spain
| | - Amaia Fernandez-Uria
- Pediatric Emergency Department, Hospital Universitario Cruces Urgencias de Pediatria, Barakaldo, Spain
| | - Javier Benito
- Department of Pediatrics, Universidad del Pais Vasco, Bilbao, Basque Country, Spain
| | - Santiago Mintegi
- Department of Pediatrics, Universidad del Pais Vasco, Bilbao, Basque Country, Spain
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Victoria TSR, Yong-Kwang OG, Pin LK, Sashikumar G, Shu-Ling C. Pyrexia in a young infant - is height of fever associated with serious bacterial infection? BMC Pediatr 2022; 22:188. [PMID: 35395789 PMCID: PMC8991795 DOI: 10.1186/s12887-022-03264-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Febrile infants ≤ 90 days old make up a significant proportion of patients seeking care in the emergency department (ED). These infants are vulnerable to serious bacterial infections (SBIs) and early identification is required to initiate timely investigations and interventions. We aimed to study if height of an infant's temperature on presentation to the ED is associated with SBI. METHODS We performed a retrospective chart review on febrile infants ≤ 90 days old presenting to our ED between 31st March 2015 and 28th February 2016. We compared triage temperature of febrile infants with and without SBIs. We presented sensitivity, specificity, positive and negative predictive values (PPV and NPV) of fever thresholds at triage. A multivariable regression was performed to study the association between height of temperature and the presence of SBI, and presented the adjusted odds ratio (aOR) with corresponding 95% confidence intervals (CI). RESULTS Among 1057 febrile infants analysed, 207 (19.6%) had a SBI. Mean temperature of infants with a SBI was significantly higher than those without (mean 38.5 °C, standard deviation, SD 0.6 vs. 38.3 °C, SD 0.5, p < 0.005). For temperature ≥ 39 °C, sensitivity, specificity, PPV and NPV for SBI was 15.5% (95%CI 10.8-21.1%), 90.4% (95%CI 88.2-92.3%), 28.1% (95%CI 21.1-36.3%) and 81.4% (95%CI 80.5-82.4%) respectively. The height of fever was consistently associated with SBI after adjusting for age, gender and SIS (aOR 1.76, 95% CI 1.32-2.33, p < 0.001). However, 32 (15.5%) infants with SBIs had an initial triage temperature ≤ 38 °C. CONCLUSIONS A higher temperature at triage was associated with a higher risk of SBI among febrile infants ≤ 90 days old. However, height of temperature must be used in conjunction with other risk factors to identify SBIs in young infants.
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Affiliation(s)
- Tan Shi Rui Victoria
- Department of Paediatrics, KK Women's and Children's Hospital Singapore, 100, Bukit Timah Road, Singapore, 229899, Singapore.
| | - Ong Gene Yong-Kwang
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Lee Khai Pin
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ganapathy Sashikumar
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Chong Shu-Ling
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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Hollaway W, Borland ML. Return visits to the paediatric emergency department. Emerg Med Australas 2022; 34:584-589. [PMID: 35322579 DOI: 10.1111/1742-6723.13961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/18/2022] [Accepted: 01/22/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the rate of unplanned return visits (uRVs) within 48 h to a paediatric ED over a 12-month period and describe the factors associated with these uRV. METHODS Retrospective review of electronic data regarding the initial and follow-up visit at a tertiary paediatric hospital ED in Western Australia. The primary outcome was the number of patients who presented for uRV within 48 h of their initial ED visit. RESULTS Between August 2018 and July 2019, 2322 patients returned to the ED for a uRV comprising 3.4% of 68 352 ED presentations with more than 53% returning with infectious causes. Triage category 3 patients were most likely to represent (OR 1.11, P = 0.029) with 3-month to 1-year old (OR 1.37, P < 0.00001) and 1-5-year old (OR 1.32, P < 0.00001) the commonest age groups. There was seasonal variation in uRVs demonstrating a greater number in the winter months. The percentage of uRVs to overall ED presentations was greater in the summer months (3.8-4.1%). There was a significant increase in uRVs occurring up to 2 weeks after the changeovers in middle-grade ED doctors only. CONCLUSIONS The present study has demonstrated associations between uRV and initial-visit triage category 3, age between 3 months and 5 years, and presentations because of infectious illness. Middle-grade doctor changeover was also associated with an increase in uRVs.
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Affiliation(s)
- William Hollaway
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,Divisions of Health and Medical Sciences (Pediatrics and Emergency Medicine), The University of Western Australia, Perth, Western Australia, Australia
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11
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Mace AO, Barnes R, Blyth CC, Martin AC, Richmond PC, Snelling TL, Moore HC. Predictors of hospital readmission in infants less than 3 months old. J Paediatr Child Health 2021; 57:533-540. [PMID: 33159397 DOI: 10.1111/jpc.15256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/18/2020] [Indexed: 11/29/2022]
Abstract
AIM To examine rates and predictors of 7-day readmission in infants hospitalised before 3 months of age with infectious and non-infectious conditions. METHODS Retrospective population-based data-linkage study of 121 854 infants from a 5-year metropolitan birth cohort (2008-2012). Cox proportional hazard models were used to examine associations between infant and maternal factors with 7-day readmission. RESULTS A total of 11 669 (9.6%) infants were hospitalised at least once by 3 months of age (median 23 days old, 56% male) with 12 602 total index hospitalisations. Infection-related conditions accounted for 29.4% (n = 3705). Readmission within 7 days occurred after 4.8% of all index hospitalisations and 5.4% of infection-related hospitalisations. Age ≤21 days was the strongest readmission risk factor (hazard ratio 7.7 (95% confidence interval 4.7-12.7) compared to infants 61-90 days old). Other risk factors included shorter index hospitalisations, younger maternal age and multi-gravidity. CONCLUSION Hospitalisations and readmissions occur for many young infants. Risk factors for readmission should inform risk-based management guidelines.
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Affiliation(s)
- Ariel O Mace
- Department of General Paediatrics, Perth Children's Hospital, Perth, Western Australia, Australia.,Department of Paediatrics, Fiona Stanley Hospital, Perth, Western Australia, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Rosanne Barnes
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.,PathWest Laboratory Medicine WA, QEII Medical Centre, Perth, Western Australia, Australia
| | - Andrew C Martin
- Department of General Paediatrics, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Peter C Richmond
- Department of General Paediatrics, Perth Children's Hospital, Perth, Western Australia, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia.,School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Tom L Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
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12
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Elgoibar B, Gangoiti I, Garcia‐Garcia JJ, Hernandez‐Bou S, Gomez B, Martinez Indart L, Mintegi S. Paediatric Escherichia coli bacteraemia presentations and high-risk factors in the emergency department. Acta Paediatr 2021; 110:1032-1037. [PMID: 32815584 DOI: 10.1111/apa.15549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/29/2020] [Accepted: 08/18/2020] [Indexed: 01/05/2023]
Abstract
AIM Escherichia coli (E coli) is a known cause of paediatric bacteraemia. The main objective was to characterise the emergency department (ED) presentations of paediatric E coli bacteraemia and secondarily to identify those related to greater severity. METHODS This was a sub-study of a multicentre cross-sectional prospective registry including all with E coli bacteraemia episodes between 2011 and 2016. We used multiple correspondence and cluster analysis to identify different patterns. RESULTS We included 291 patients and 43 met criteria for severe disease (14.3%, 95% confidence interval 11.2-19.3). We identified four types of paediatric E coli bacteraemia presentations. Two (178 patients, 61.2%) were related to well-appearing previously healthy infants with associated urinary tract infection (UTI). Well-appearing children older than 12 months old with underlying disease (n = 60, 20.6%) and non-well-appearing children of different ages (n = 53, 18.2%) corresponded to the other two types; these had associated UTI infrequently and higher severity rate (15% and 50.9%, respectively, higher when compared with the two previous types, P < .01), including the two patients who died. CONCLUSION There were four different types of ED paediatric E coli bacteraemia presentations with different severity. Febrile young children with associated UTI showed the best outcome.
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Affiliation(s)
- Borja Elgoibar
- Paediatric Emergency Department Biocruces Bizkaia Health Research Institute Hospital Universitario Cruces University of the Basque Country UPV/EHU Bilbao, Basque Country Spain
| | - Iker Gangoiti
- Paediatric Emergency Department Biocruces Bizkaia Health Research Institute Hospital Universitario Cruces University of the Basque Country UPV/EHU Bilbao, Basque Country Spain
| | | | | | - Borja Gomez
- Paediatric Emergency Department Biocruces Bizkaia Health Research Institute Hospital Universitario Cruces University of the Basque Country UPV/EHU Bilbao, Basque Country Spain
| | | | - Santiago Mintegi
- Paediatric 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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13
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Mace AO, Martin AC, Ramsay J, Totterdell J, Marsh JA, Snelling T. FeBRILe3 Project: protocol for a prospective pragmatic, multisite observational study and safety evaluation assessing Fever, Blood cultures and Readiness for discharge in Infants Less than 3 months old. BMJ Open 2020; 10:e035992. [PMID: 32404395 PMCID: PMC7228564 DOI: 10.1136/bmjopen-2019-035992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The purpose of this observational study is to assess the safety and impact of the introduction of a clinical practice guideline (CPG) recommending early discharge of infants with fever without source who are at low risk of serious bacterial infection (SBI). We hypothesise that implementation of this guideline will be associated with a rate of unplanned readmission to hospital (within 7 days of discharge) which is similar (ie, non-inferior) to that observed under previous standard practice. METHODS AND ANALYSIS This observational study is a prospective pragmatic, multisite safety assessment and impact project. It will evaluate the safety of a CPG which allows febrile infants fulfilling low-risk criteria to be discharged early from hospital if their blood cultures demonstrate no growth at 24 hours (compared with previous minimum 48 hours admission). This guideline has been implemented at two Western Australian metropolitan hospitals. Infants aged <3 months (chronological or corrected for premature birth before 37 weeks gestation) presenting with fever without source will be included. The primary outcome is readmission to hospital due to clinical deterioration/caregiver concern within 7 days of discharge, identified through review of electronic admission details and study-specific caregiver surveys. Secondary outcomes include rates of SBI, hospital lengths of stay compared with previous practice, clinician guideline adherence and caregiver satisfaction with the discharge process. Analysis will be within a sequential Bayesian safety monitoring framework, which incorporates new information and updates the evidence for guideline safety relative to previous practice (historical control) at prespecified interim analyses. Demographic and clinical information will be summarised. ETHICS AND DISSEMINATION Ethics approval and waiver of consent for data collection has been granted by the Child and Adolescent Health Service Human Research Ethics Committee (RGS0000001415). Caregivers will have the option to opt out of survey follow-up. Results will be disseminated via peer-reviewed publication. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12619001010189).
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Affiliation(s)
- Ariel Olivia Mace
- Department of Paediatrics, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Wesfarmer's Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Andrew C Martin
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Jessica Ramsay
- Wesfarmer's Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - James Totterdell
- Wesfarmer's Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Julie A Marsh
- Wesfarmer's Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- School of Mathematics & Statistics, The University of Western Australia, Perth, Western Australia, Australia
| | - Tom Snelling
- Wesfarmer's Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Curtin University, Perth, Western Australia, Australia
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14
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Jameson M, Edmunds Otter M, Williams C, Modha D, Lim F, Conroy SP. Which near-patient tests might improve the diagnosis of UTI in older people in urgent care settings? A mapping review and consensus process. Eur Geriatr Med 2019; 10:707-720. [PMID: 34652709 DOI: 10.1007/s41999-019-00222-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/19/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to map out the existing knowledge on near-patient tests for urinary tract infections, and use a consensus building approach to identify those which might be worthy of further evaluation in the urgent care context, defined as clinically useful and feasible results available within 4-24 h. METHODS A systematic search for reviews describing diagnostic tests for UTI was undertaken in Medline, EMBASE, Cochrane database of systematic reviews and CINAHL selected reviews were retained according to a priori inclusion and exclusion criteria, and then graded for quality using the CASP tool for reviews. A consensus process involving microbiologists and chemical pathologists helped identify which test might conceivably be applied in the urgent care context (e.g. Emergency Department, giving results within 24 h). RESULTS The initial search identified 1079 papers, from which 26 papers describing 35 diagnostic tests were retained for review. The overall quality was limited, with only 7/26 retained papers scoring more than 50% on the CASP criteria. Reviews on urine dipstick testing reported wide confidence intervals for sensitivity and specificity; several raised concerns about urine dip testing in older people. A number of novel biomarkers were reported upon but appeared not to be helpful in differentiating infection from asymptomatic bacteriuria. Blood markers such as CRP and procalcitonin were reported to be helpful in monitoring rather than diagnosing UTI. The consensus process helped to refine the 35 test down to 17 that might be useful in the urgent care context: urinalysis (nitrites and leucocytes), uriscreen catalase test, lactoferrin, secretory immunoglobulin A, xanthine oxidase, soluble triggering receptor expressed on myeloid cells, A-1 microglobulin (a1 Mg) and a1 Mg/creatinine ratio, cytokine IL-6, RapidBac, MALDI-TOF, electronic noses, colorimetric sensor arrays, electro chemical biosensor, WBC count (blood), C-reactive peptide, erythrocyte sedimentation rate. CONCLUSIONS A wide range of diagnostic tests have been explored to diagnose UTI, but, in general, have been poorly evaluated or have wide variation in predictive properties. This study identified 17 tests for UTI that seemed to offer some primes and merit further evaluation for diagnosing UTI in older people in urgent care settings.
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Affiliation(s)
- Molly Jameson
- Department of Health Sciences, University of Leicester, George Davies Centre, Room 3.37, University Road, Leicester, LE1 7RH, UK
| | - Mary Edmunds Otter
- Department of Health Sciences, University of Leicester, George Davies Centre, Room 3.37, University Road, Leicester, LE1 7RH, UK
| | - Christopher Williams
- Department of Health Sciences, University of Leicester, George Davies Centre, Room 3.37, University Road, Leicester, LE1 7RH, UK
| | - Deborah Modha
- Department of Microbiology, University Hospitals of Leicester, Leicester, UK
| | - Felicia Lim
- Department of Microbiology, University Hospitals of Leicester, Leicester, UK
| | - Simon P Conroy
- Department of Health Sciences, University of Leicester, George Davies Centre, Room 3.37, University Road, Leicester, LE1 7RH, UK.
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15
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Carlier A, Berkhof JG, Rozing M, Bouckaert F, Sienaert P, Eikelenboom P, Veerhuis R, Vandenbulcke M, Berkhof J, Stek ML, Rhebergen D, Dols A, Exel EV. Inflammation and remission in older patients with depression treated with electroconvulsive therapy; findings from the MODECT study ✰. J Affect Disord 2019; 256:509-516. [PMID: 31279250 DOI: 10.1016/j.jad.2019.06.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/07/2019] [Accepted: 06/30/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Compelling evidence links elevated levels of C-reactive protein (CRP) and other inflammatory markers to poor treatment outcome of antidepressant medication. Little is known about the contribution of low-grade inflammation to treatment response to electroconvulsive therapy (ECT) in severely depressed patients. METHOD Associations between serum levels of CRP, interleukin-6, interleukin-10, and tumour necrosis factor-α as well as remission of depression, time to remission, and speed of decline of depressive symptoms were examined in 95 older (mean age: 73.1 years) depressed patients treated with ECT. RESULTS Moderately elevated levels of CRP at baseline (3 to 10 mg/L), but no other inflammatory markers, were associated with higher remission rates. In patients with moderately elevated CRP levels, the odds ratio for remission was 3.62 (95% confidence interval [CI], 1.09-11.97; p = 0.04). Time to remission was shorter in those with moderately elevated CRP levels (p = 0.05). Speed of decline was higher in patients with moderately elevated CRP levels as compared with those with low CRP levels (decline of 3.2 Montgomery Åsberg Depression Rating Scale points per administration vs. 2.3 points per administration, p = 0.03). LIMITATIONS Because of the observational design, residual confounding through other lifestyle or demographic factors cannot be ruled out. CONCLUSIONS Although earlier studies showed that low-grade inflammation contributes to poor treatment response in those treated with antidepressants, our study provides clues that low-grade inflammation does not have such a detrimental effect on the treatment response to ECT. This is underscored by our finding that moderately elevated CRP levels were associated with increased remission rates in depressed patients treated with ECT. Replication studies are warranted.
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Affiliation(s)
- Angela Carlier
- GGZ inGeest Specialized Mental Health Care, Department of Old Age Psychiatry, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute and NCA Neuroscience Amsterdam, the Netherlands.
| | - Johanna G Berkhof
- GGZ inGeest Specialized Mental Health Care, Department of Old Age Psychiatry, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands
| | - Maarten Rozing
- Section of General Practice, Department of Public Health, University of Copenhagen
| | - Filip Bouckaert
- KU Leuven, University Psychiatric Centre KU Leuven, department of Old Age Psychiatry, Leuven/Kortenberg, Belgium; KU Leuven, University Psychiatric Centre KU Leuven, Academic Center for ECT and Neuromodulation, Leuven/Kortenberg, Belgium
| | - Pascal Sienaert
- KU Leuven, University Psychiatric Centre KU Leuven, Academic Center for ECT and Neuromodulation, Leuven/Kortenberg, Belgium
| | - Piet Eikelenboom
- GGZ inGeest Specialized Mental Health Care, Department of Old Age Psychiatry, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands
| | - Robert Veerhuis
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute and NCA Neuroscience Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Clinical Chemistry department, the Netherlands
| | - Mathieu Vandenbulcke
- KU Leuven, University Psychiatric Centre KU Leuven, department of Old Age Psychiatry, Leuven/Kortenberg, Belgium
| | - Johannes Berkhof
- Amsterdam UMC, Vrije Universiteit Amsterdam, department of Epidemiology & Biostatistics, the Netherlands
| | - Max L Stek
- GGZ inGeest Specialized Mental Health Care, Department of Old Age Psychiatry, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute and NCA Neuroscience Amsterdam, the Netherlands
| | - Didi Rhebergen
- GGZ inGeest Specialized Mental Health Care, Department of Old Age Psychiatry, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute and NCA Neuroscience Amsterdam, the Netherlands
| | - Annemiek Dols
- GGZ inGeest Specialized Mental Health Care, Department of Old Age Psychiatry, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute and NCA Neuroscience Amsterdam, the Netherlands
| | - Eric van Exel
- GGZ inGeest Specialized Mental Health Care, Department of Old Age Psychiatry, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute and NCA Neuroscience Amsterdam, the Netherlands
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16
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Epidemiology of Serious Bacterial Infections in Infants Less Than 90 Days of Age, Presenting to a Tertiary Care Emergency Department, 2010 to 2016. Pediatr Infect Dis J 2019; 38:e161-e163. [PMID: 30408003 DOI: 10.1097/inf.0000000000002241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Serious infections in infants require urgent treatment. Microbiology of bacterial isolates obtained from children younger than 90 days of was reviewed. Nine-hundred thirty-two infants were identified (mean age of 39 days). Seventy-four percent of organisms obtained were relevent. Common pathogens identified were Escherichia coli, Streptococcus agalactiae and Staphylococcus aureus. Emergence of S. aureus (18% methicillin resistant S. aureus (MRSA)) and ampC producing enterobacteriaceae requires prompt attention.
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17
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Affiliation(s)
- John M Morrison
- Johns Hopkins All Children's Hospital, Saint Petersburg, Florida; and
| | - Robert A Dudas
- Johns Hopkins All Children's Hospital, Saint Petersburg, Florida; and
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kimberly Collins
- Johns Hopkins All Children's Hospital, Saint Petersburg, Florida; and
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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18
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Jung N, Byun HJ, Park JH, Kim JS, Kim HW, Ha JY. Diagnostic accuracy of urinary biomarkers in infants younger than 3 months with urinary tract infection. KOREAN JOURNAL OF PEDIATRICS 2018; 61:24-29. [PMID: 29441109 PMCID: PMC5807987 DOI: 10.3345/kjp.2018.61.1.24] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/25/2017] [Accepted: 09/26/2017] [Indexed: 01/11/2023]
Abstract
Purpose The aim of this study was to evaluate the diagnostic accuracy of urinary biomarkers, such as neutrophil gelatinase-associated lipocalin (uNGAL) and β-2 microglobulin (uB2MG), in early detection of urinary tract infection (UTI) in infants aged <3 months with fever. Methods A total of 422 infants aged <3 months (male:female=267:155; mean age, 56.4 days), who were admitted for fever, were retrospectively included in this study. We compared uNGAL and uB2MG between the UTI and non-UTI groups at the time of admission. The sensitivity, specificity, accuracy, and area under the curve (AUC) of uNGAL and uB2MG for use in diagnosing UTI were assessed. Results Among 422 patients, 102 (24.2%) were diagnosed with UTI. Levels of uNGAL were higher in the UTI group than in the non-UTI group (366.6 ng/mL vs. 26.9 ng/mL, P<0.001). Levels of uB2MG were not different between the 2 groups. Multivariate analysis revealed that uNGAL was an independent predictive factor for UTI (P=0.033). The sensitivity, specificity, and accuracy were 90.2%, 92.5%, and 91.9% for uNGAL, and 48.0%, 43.8%, and 44.8% for uB2MG, respectively. AUC of uNGAL was 0.942 and that of uB2MG was 0.407. Conclusion Accuracy of uNGAL in the diagnosis of UTI is high in febrile infants aged <3 months. uNGAL can help in the early diagnosis and treatment of UTI in infants.
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Affiliation(s)
- Nani Jung
- Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea
| | - Hye Jin Byun
- Department of Urology, Keimyung University School of Medicine, Daegu, Korea
| | - Jae Hyun Park
- Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea
| | - Joon Sik Kim
- Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea
| | - Hae Won Kim
- Department of Nuclear Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Ji Yong Ha
- Department of Urology, Keimyung University School of Medicine, Daegu, Korea
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