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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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2
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Green RS, Sartori LF, Florin TA, Aronson PL, Lee BE, Chamberlain JM, Hunt KM, Michelson KA, Nigrovic LE. Predictors of Invasive Bacterial Infection in Febrile Infants Aged 2 to 6 Months in the Emergency Department. J Pediatr 2024; 270:114017. [PMID: 38508484 DOI: 10.1016/j.jpeds.2024.114017] [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: 12/08/2023] [Revised: 02/29/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
Our goal was to identify predictors of invasive bacterial infection (ie, bacteremia and bacterial meningitis) in febrile infants aged 2-6 months. In our multicenter retrospective cohort, older age and lower temperature identified infants at low risk for invasive bacterial infection who could safely avoid routine testing.
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Affiliation(s)
- Rebecca S Green
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.
| | - Laura F Sartori
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Todd A Florin
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Paul L Aronson
- Section of Pediatric Emergency Medicine, Departments of Pediatrics and of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Brian E Lee
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | - James M Chamberlain
- Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | - Kathryn M Hunt
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Kenneth A Michelson
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lise E Nigrovic
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
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3
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Burstein B, Lirette MP, Beck C, Chauvin-Kimoff L, Chan K. La prise en charge des nourrissons de 90 jours ou moins, fiévreux mais dans un bon état général. Paediatr Child Health 2024; 29:50-66. [PMID: 38332975 PMCID: PMC10848124 DOI: 10.1093/pch/pxad084] [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: 12/14/2021] [Accepted: 06/15/2022] [Indexed: 02/10/2024] Open
Abstract
On constate des pratiques très variées en matière d'évaluation et de prise en charge des jeunes nourrissons fiévreux. Bien que la plupart des jeunes nourrissons fiévreux mais dans un bon état général soient atteints d'une maladie virale, il est essentiel de détecter ceux qui sont à risque de présenter des infections bactériennes invasives, notamment une bactériémie et une méningite bactérienne. Le présent document de principes porte sur les nourrissons de 90 jours ou moins dont la température rectale est de 38,0 °C ou plus, mais qui semblent être dans un bon état général. Il est conseillé d'appliquer les récents critères de stratification du risque pour orienter la prise en charge, ainsi que d'intégrer la procalcitonine à l'évaluation diagnostique. Les décisions sur la prise en charge des nourrissons qui satisfont aux critères de faible risque devraient refléter la probabilité d'une maladie, tenir compte de l'équilibre entre les risques et les préjudices potentiels et faire participer les parents ou les proches aux décisions lorsque diverses options sont possibles. La prise en charge optimale peut également dépendre de considérations pragmatiques, telles que l'accès à des examens diagnostiques, à des unités d'observation, à des soins tertiaires et à un suivi. Des éléments particuliers, tels que la mesure de la température, le risque d'infection invasive à Herpes simplex et la fièvre postvaccinale, sont également abordés.
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Affiliation(s)
- Brett Burstein
- Société canadienne de pédiatrie, comité des soins aigus, Ottawa (Ontario)Canada
| | - Marie-Pier Lirette
- Société canadienne de pédiatrie, comité des soins aigus, Ottawa (Ontario)Canada
| | - Carolyn Beck
- Société canadienne de pédiatrie, comité des soins aigus, Ottawa (Ontario)Canada
| | | | - Kevin Chan
- Société canadienne de pédiatrie, comité des soins aigus, Ottawa (Ontario)Canada
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4
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Burstein B, Lirette MP, Beck C, Chauvin-Kimoff L, Chan K. Management of well-appearing febrile young infants aged ≤90 days. Paediatr Child Health 2024; 29:50-66. [PMID: 38332970 PMCID: PMC10848123 DOI: 10.1093/pch/pxad085] [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: 12/14/2021] [Accepted: 06/15/2022] [Indexed: 02/10/2024] Open
Abstract
The evaluation and management of young infants presenting with fever remains an area of significant practice variation. While most well-appearing febrile young infants have a viral illness, identifying those at risk for invasive bacterial infections, specifically bacteremia and bacterial meningitis, is critical. This statement considers infants aged ≤90 days who present with a rectal temperature ≥38.0°C but appear well otherwise. Applying recent risk-stratification criteria to guide management and incorporating diagnostic testing with procalcitonin are advised. Management decisions for infants meeting low-risk criteria should reflect the probability of disease, consider the balance of risks and potential harm, and include parents/caregivers in shared decision-making when options exist. Optimal management may also be influenced by pragmatic considerations, such as access to diagnostic investigations, observation units, tertiary care, and follow-up. Special considerations such as temperature measurement, risk for invasive herpes simplex infection, and post-immunization fever are also discussed.
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Affiliation(s)
- Brett Burstein
- Canadian Paediatric Society, Acute Care Committee, Ottawa, Ontario, Canada
| | - Marie-Pier Lirette
- Canadian Paediatric Society, Acute Care Committee, Ottawa, Ontario, Canada
| | - Carolyn Beck
- Canadian Paediatric Society, Acute Care Committee, Ottawa, Ontario, Canada
| | | | - Kevin Chan
- Canadian Paediatric Society, Acute Care Committee, Ottawa, Ontario, Canada
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5
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Shimony-Kanat S, Gofin R, Nator N, Solt I, Abu Ahmad W, Liebergall Wischnitzer M, Lawen H, Kopitman A, Crassac V, Kerem E. Mothers' Knowledge of Infants' Fever Management: A National Prospective Study. Matern Child Health J 2023; 27:815-823. [PMID: 36869983 DOI: 10.1007/s10995-023-03593-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVES The aim of this study was to describe mothers' knowledge of infant fever management after birth and six months later and its association with sociodemographic characteristics, perceived support, sources of consultation and health education; and to assess determinants of change in mother's knowledge from birth to six months. METHODS Mothers (n = 2804) answered a self-reporting questionnaire after giving birth in maternity wards in six hospitals in Israel; six months later follow- up interviews were conducted by telephone. RESULTS The mothers' knowledge level of infant fever management was low after birth (mean = 50.5, range 0-100, SD = 16.1), and rose to a moderate level six months later (mean = 65.2, SD = 15.0). Mothers having their first born, with lower household income or education were less knowledgeable about infant fever management after birth. However, these mothers showed the largest improvement after six months. Mothers' perceived support or sources of consultation and health education (partner, family, friends, nurses, and physicians) were not associated with their knowledge at either time. Moreover, mothers stated self-learning from internet and other media as often as receiving health education by health professionals. CONCLUSIONS FOR PRACTICE Public health policy for health professionals in hospitals and community clinics is essential to promote clinical interventions promoting mothers' knowledge of infant fever management. Efforts should focus at first time mothers, those with non-academic education, and those with a moderate or low household income. Public health policy enhancing communication with mothers regarding fever management in hospitals and community health settings, as well as accessible means of self-learning is warranted.
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Affiliation(s)
- Sarit Shimony-Kanat
- Faculty of Medicine, Hadassah Hebrew University School of Nursing, POB 12000, 91120, Jerusalem, Israel.
| | - Rosa Gofin
- School of Public Health and Community Medicine Hadassah, Hebrew University, in the Faculty of Medicine, Jerusalem, Israel
| | - Nidaa Nator
- Faculty of Medicine, Hadassah Hebrew University School of Nursing, POB 12000, 91120, Jerusalem, Israel
| | - Ido Solt
- Rambam Medical Center, Haifa, Israel
| | - Wiessam Abu Ahmad
- School of Public Health and Community Medicine Hadassah, Hebrew University, in the Faculty of Medicine, Jerusalem, Israel
| | | | - Heba Lawen
- Faculty of Medicine, Hadassah Hebrew University School of Nursing, POB 12000, 91120, Jerusalem, Israel
| | | | | | - Eitan Kerem
- Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Cristina Vergara Alvarez S, José Leiva Alaniz M, Victoria Mestre Furlani M, Vazquez F, Mancha Agresti P, Cristina Nally M, Paola Maturano Y. Bioprospecting of the probiotic potential of yeasts isolated from a wine environment. Fungal Genet Biol 2023; 164:103767. [PMID: 36529368 DOI: 10.1016/j.fgb.2022.103767] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 12/02/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
Autochthonous yeasts of oenological origin are adapted to highly stressful and selective environments, which makes them potential candidates for probiotics. The objective of the present study was to explore the probiotic potential of 96 native yeasts of oenological origin, their biosafety, resistance to gastrointestinal tract conditions and adhesion properties. Regarding biosafety, 66 isolates shown negative hemolytic activity, negative urease activity and susceptibility to 3 or more antifungals. After the gastrointestinal resistance test, 15 isolates were selected that showed growth at different temperatures, tolerance to low pH and the presence of bile salts in in vitro tests. In general, survival after simulated conditions of the gastrointestinal tract was high and more restrictive was the duodenal. The results of the adhesion properties showed highly variable hydrophobicity and a high percentage of autoaggregation at 24 h. The maximum production of biofilm was detected in the Pichia strains. Of a total of 96 yeast strains, 15 non-Saccharomyces yeasts presented suitable properties as probiotic candidates. The native winemaking strains performed better than the reference probiotic strain, Saccharomyces cerevisiae var. boulardii CNCM I-745, which reaffirms that these strains are promising probiotic candidates and further studies are necessary to confirm their probiosis.
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Affiliation(s)
- Silvia Cristina Vergara Alvarez
- Instituto de Biotecnología, Universidad Nacional de San Juan, Av. San Martín 1109 (O), San Juan 5400, Argentina; Consejo Nacional de Investigaciones Científicas y Tecnológicas, Godoy Cruz 2290 Ciudad Autónoma de Buenos Aires C1425FQB, Argentina.
| | - María José Leiva Alaniz
- Instituto de Biotecnología, Universidad Nacional de San Juan, Av. San Martín 1109 (O), San Juan 5400, Argentina; Consejo Nacional de Investigaciones Científicas y Tecnológicas, Godoy Cruz 2290 Ciudad Autónoma de Buenos Aires C1425FQB, Argentina.
| | - María Victoria Mestre Furlani
- Instituto de Biotecnología, Universidad Nacional de San Juan, Av. San Martín 1109 (O), San Juan 5400, Argentina; Consejo Nacional de Investigaciones Científicas y Tecnológicas, Godoy Cruz 2290 Ciudad Autónoma de Buenos Aires C1425FQB, Argentina
| | - Fabio Vazquez
- Instituto de Biotecnología, Universidad Nacional de San Juan, Av. San Martín 1109 (O), San Juan 5400, Argentina
| | - Pamela Mancha Agresti
- CEFET Centro Federal de Educação Tecnológica, Av. Amazonas, 5253 Belo Horizonte, Mina Gerais 30421-169, Brasil
| | - María Cristina Nally
- Instituto de Biotecnología, Universidad Nacional de San Juan, Av. San Martín 1109 (O), San Juan 5400, Argentina; Consejo Nacional de Investigaciones Científicas y Tecnológicas, Godoy Cruz 2290 Ciudad Autónoma de Buenos Aires C1425FQB, Argentina
| | - Yolanda Paola Maturano
- Instituto de Biotecnología, Universidad Nacional de San Juan, Av. San Martín 1109 (O), San Juan 5400, Argentina; Consejo Nacional de Investigaciones Científicas y Tecnológicas, Godoy Cruz 2290 Ciudad Autónoma de Buenos Aires C1425FQB, Argentina
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7
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Cozzi G, Tessitore A, Giangreco M, Cogo P, Valentini E, Salis S, Pascolo P, Barbi E. SBI is uncommon in the absence of paediatricians' gut feeling and abnormal respiratory pattern. Acta Paediatr 2022; 111:2362-2368. [PMID: 36114734 PMCID: PMC9826455 DOI: 10.1111/apa.16544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/29/2022] [Accepted: 09/15/2022] [Indexed: 01/11/2023]
Abstract
AIM According to the Italian national statistical institute, severe bacterial infections (SBI) in Italy are responsible for 1.7% of mortality under 5 years of age and their recognition is often challenging, especially in the first stages of the disease. We tried to estimate the prevalence of SBI in our target population and to identify signs and symptoms that could guide in the initial evaluation of a child with a possible SBI. METHODS We designed a prospective, multicentre study and enrolled patients aged 0-14 years at the first evaluation to the emergency department with an acute illness lasting a maximum of 5 days. The presence of variables suggestive of SBI was collected for every enrolled patient. One week after the enrolment, every patient was followed up by telephone. RESULTS SBI is more likely to be detected with the 'gut feeling' in both univariate and multivariate models (univariate OR: 7.16, 95% CI: 4.08-12.56; multivariate OR: 5.34, 95% CI: 2.78-10.25), while abnormal breathing pattern resulted significative only in univariate model (OR 3.83, 95% CI: 1.98-7.40). Nevertheless, their associated sensitivity is low. CONCLUSION SBI is uncommon in the absence of paediatricians' gut feeling and abnormal respiratory pattern.
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Affiliation(s)
- Giorgio Cozzi
- Institute for Maternal and Child Health ‐ IRCCS Burlo GarofoloTriesteItaly
| | | | - Manuela Giangreco
- Institute for Maternal and Child Health ‐ IRCCS Burlo GarofoloTriesteItaly
| | - Paola Cogo
- Department of MedicineUniversity Hospital of UdineUdineItaly
| | - Elena Valentini
- Department of MedicineUniversity Hospital of UdineUdineItaly
| | - Simona Salis
- Pediatric Clinic, Maternal and Child DepartmentSant'Antonio Hospital, San Daniele del FriuliItaly
| | - Paola Pascolo
- Pediatric Clinic, Maternal and Child DepartmentSan Polo HospitalMonfalconeItaly
| | - Egidio Barbi
- Institute for Maternal and Child Health ‐ IRCCS Burlo GarofoloTriesteItaly,University of TriesteTriesteItaly
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Baker AH, Monuteaux MC, Michelson KA, Neuman MI. Resolution of Fever in the Pediatric Emergency Department and Bacteremia. Clin Pediatr (Phila) 2022; 62:474-480. [PMID: 36401509 DOI: 10.1177/00099228221138212] [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] [Indexed: 11/21/2022]
Abstract
To determine whether a lack of response to antipyretics was associated with bacteremia, we performed a cross-sectional study involving children with an initial temperature ≥38°C presenting to a pediatric emergency department (ED) from 2012 to 2020 who received an antipyretic and had a blood culture obtained. We assessed the association of resolution of fever at specific time points after antipyretic administration with bacteremia adjusting for age, complex chronic condition, blood culture source, type of antipyretic, and height of temperature. Among 6319 febrile children, 242 (3.8%) had bacteremia. The adjusted odds ratio of bacteremia was 1.6 (95% confidence interval: 1.2-2.2) among children who remained febrile at 180 minutes and 1.7 (1.2-2.4) among children who remained febrile at 240 minutes. Among febrile children presenting to a tertiary care ED for whom a blood culture was obtained, the response to an antipyretic varies based on the presence or absence of bacteremia.
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Affiliation(s)
- Alexandra H Baker
- Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Michael C Monuteaux
- Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Kenneth A Michelson
- Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Mark I Neuman
- Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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9
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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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10
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Hu B, Chen TM, Liu SP, Hu HL, Guo LY, Chen HY, Li SY, Liu G. Fever of unknown origin (FUO) in children: a single-centre experience from Beijing, China. BMJ Open 2022; 12:e049840. [PMID: 35296470 PMCID: PMC8928314 DOI: 10.1136/bmjopen-2021-049840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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
OBJECTIVE To date, there is no standard diagnostic practice to identify the underlying disease-causing mechanism for paediatric patients suffering from chronic fever without any specific diagnosis, which is one of the leading causes of death in paediatric patients. Therefore, we aimed this retrospective study to analyse medical records of paediatric patients with fever of unknown origin (FUO) to provide a preliminary basis for improving the diagnostic categories and facilitate the treatment outcomes. DESIGN A retrospective study. SETTING Beijing Children's Hospital. PARTICIPANTS Clinical data were collected from 1288 children between 1 month and 18 years of age diagnosed with FUO at Beijing Children's Hospital between January 2010 and December 2017. INTERVENTIONS According to the aetiological composition, age, duration of fever and laboratory examination results, the diagnostic strategies were analysed and formulated. PRIMARY AND SECONDARY OUTCOME MEASURES The statistical analyses were carried out using SPSS V.24.0 platform along with the χ2 test and analysis of variance (p<0.05). RESULTS The duration of fever ranged from 2 weeks to 2 years, with an average of 6 weeks. There were 656 cases (50.9%) of infectious diseases, 63 cases (4.9%) of non-infectious inflammatory diseases (NIIDs), 86 cases (6.7%) of neoplastic diseases, 343 cases (26.6%) caused by miscellaneous diseases and 140 cases (10.9%) were undiagnosed. With increasing age, the proportion of FUO from infectious diseases gradually decreased from 73.53% to 44.21%. NIID was more common in children over 3 years old, and neoplastic diseases mainly occurred from 1 to 6 years of age. Among miscellaneous diseases, the age distribution was mainly in school-aged children over 6 years. Respiratory tract infection was the most common cause of FUO in children, followed by bloodstream infections. Bacterial infection was the most common cause in children with less than 1 year old, while the virus was the main pathogen in children over 1 year old. CONCLUSIONS The diagnosis of neoplastic diseases and miscellaneous diseases-related diseases still depends mainly on invasive examination. According to our clinical experience, the diagnostic process was formulated based on fever duration and the type of disease. This process can provide a guide for the diagnosis and treatment of paediatric FUO in the future.
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Affiliation(s)
- Bing Hu
- Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Tian-Ming Chen
- Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Shu-Ping Liu
- Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Hui-Li Hu
- Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Ling-Yun Guo
- Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - He-Ying Chen
- Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Shao-Ying Li
- Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Gang Liu
- Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
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11
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Marcusohn E, Gibory I, Miller A, Lipsky AM, Neuberger A, Epstein D. The association between the degree of fever as measured in the emergency department and clinical outcomes of hospitalized adult patients. Am J Emerg Med 2021; 52:92-98. [PMID: 34894473 DOI: 10.1016/j.ajem.2021.11.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/21/2021] [Accepted: 11/29/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Fever is a physiologic response to a wide range of pathologies and one of the most common complaints and clinical signs in the emergency medicine department (ED). The association between fever magnitude and clinical outcomes has been evaluated in specific populations with inconsistent results. OBJECTIVES In this study we aimed to investigate the association between the degree of fever in the ED and clinical outcomes of hospitalized febrile adult patients. METHODS This was a retrospective single-center cohort study of all the patients with maximal body temperature (BT) ≥ 38.0 °C, as recorded during the ED evaluation, who were hospitalized between January 2015 and December 2020. Patients with heatstroke were excluded. The primary outcome was 30-day all-cause mortality and secondary outcomes were intensive care unit (ICU) admission and development of acute kidney injury (AKI). RESULTS Fever was recorded among 8.1% of patients evaluated in the ED. Elevated BT was associated with increased risk of hospital admission (70.3% vs. 49.4%, p < 0.001), 30-day mortality (12.3% vs. 2.6%, p < 0.001), ICU admission (5.7% vs. 2.8%, p < 0.001), and AKI 11.7% vs. 3.8%, p < 0.001). After exclusion of nine patients with heatstroke, 21,252 hospitalized febrile patients were included in the final analysis. BT > 39.7 °C was progressively associated with increased mortality (OR 1.64-2.22, 95% CI 1.16-2.81, p < 0.005) as compared to BT 38.0-38.1 °C. More AKI events were observed in patients with BT > 39.5 °C (OR 1.48-2.91, 95% CI 1.11-3.66, p < 0.007). Temperature between 39.2 and 39.5 °C was associated with lower mortality (OR 0.62-0.71, 95% CI 0.51-0.87, p < 0.001). In a multiple logistic regression analysis BT > 39.9 °C was independently associated with increased mortality and AKI. BT > 39.7 °C was progressively associated with an increased risk of ICU admission. CONCLUSION Among febrile patients admitted to the hospital, BT > 39.5 °C was associated with adverse clinical course, as compared to patients with lower-grade fever (38.0-38.1 °C). These patients should be flagged on arrival to the ED and likely warrant more aggressive evaluation and treatment.
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Affiliation(s)
- Erez Marcusohn
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.
| | - Iftach Gibory
- Internal Medicine "H" department, Rambam Health Care Campus, Haifa, Israel
| | - Asaf Miller
- Medical Intensive Care unit, Rambam Health Care Campus, Haifa, Israel
| | - Ari M Lipsky
- Emergency Department, Emek Medical Center, Afula, Israel
| | - Ami Neuberger
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Internal Medicine "B" department, Rambam Health Care Campus, Haifa, Israel
| | - Danny Epstein
- Critical Care Division, Rambam Health Care Campus, Haifa, Israel
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12
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Vandenberk M, De Bondt K, Nuyts E, Toelen J, Verbakel JY. Shivering has little diagnostic value in diagnosing serious bacterial infection in children: a systematic review and meta-analysis. Eur J Pediatr 2021; 180:1033-1042. [PMID: 33179117 DOI: 10.1007/s00431-020-03870-7] [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: 08/15/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 11/28/2022]
Abstract
Early diagnosis of serious bacterial infections (SBI) is important for improving outcome of morbidity and mortality in children. A systematic review was conducted to examine if shivering had any value in diagnosing serious bacterial infection. We split our population (0-18 years old) into two categories depending on the presence of a known malignancy. The databases of Medline, Embase, Cinahl, and Web of Science were searched from inception until July 2019. The quality was assessed with the QUADAS-2 tool. Two by two tables were created, extracting the number of true positive (TP), true negative (TN), false positive (FP), and false negative (FN) regarding shivering and SBI, by 2 authors independently. Sensitivity, specificity, likelihood ratios, and their 95% confidence intervals were calculated using the MetaDATA Shiny app. In a population with known malignancy, we found a +LR of 3.47 (95% CI 2.58-4.36) for a serious bacterial infection when shivering was present, implying an increase of 25-30% possibility for a serious bacterial infection. In children without malignancy, diagnostic accuracy of shivering was poor.Conclusion: Shivering is of limited use to diagnose serious bacterial infection in children without malignancy. Nevertheless, in children with known malignancy, it can be useful as an alarm signal. What is Known: • In the NICE guidelines for febrile illness in children, "shivering" is considered as an intermediate risk factor ("amber" sign) for a serious illness. • A systematic literature search conducted in 2007 investigating the correlation between shivering in a febrile child and the presence of a serious bacterial infection could include only one study. What is New: • Based on the results of this systematic review, shivering has little diagnostic value in children without malignancy but can be useful as an alarm sign of serious bacterial infection in children with known malignancy. • In case of absence of shivering, serious bacterial infection cannot be ruled out.
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Affiliation(s)
| | | | - Emma Nuyts
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Jaan Toelen
- Department of Pediatrics, Division of Woman and Child, UZ Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Jan Y Verbakel
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium. .,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
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13
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Skok K, Duh M, Stožer A, Markota A, Gosak M. Thermoregulation: A journey from physiology to computational models and the intensive care unit. WILEY INTERDISCIPLINARY REVIEWS. SYSTEMS BIOLOGY AND MEDICINE 2020; 13:e1513. [PMID: 33251759 DOI: 10.1002/wsbm.1513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/24/2020] [Accepted: 11/02/2020] [Indexed: 12/19/2022]
Abstract
Thermoregulation plays a vital role in homeostasis. Many species of animals as well as humans have evolved various physiological mechanisms for body temperature control, which are characteristically flexible and enable a fine-tuned spatial and temporal regulation of body temperature in different environmental conditions and circumstances. Human beings normally maintain a core body temperature at around 37°C, and maintenance of this relatively high temperature is critical for survival. Therefore, principles of thermoregulatory control have also important clinical implications. Infections can cause the body temperature to rise internally and several diseases can cause a dysfunction of thermoregulatory mechanisms. Moreover, the utilization of thermotherapies in treating various diseases has been known for thousands of years with a recent resurgence of interest. An increasing amount of research suggests that targeted temperature management is of paramount importance to patient outcomes in certain clinical scenarios. We provide a concise summary of the basic concepts of thermoregulation. Emphasis is given to the principles of thermoregulation in humans in basic pathological states and to targeted temperature management strategies in the clinical environment, with special attention on therapeutic hypothermia in postcardiac arrest patients. Finally, the discussion is focused on the potential offered by computational thermophysiological models for predicting thermal responses of patients in various clinical circumstances, for proposing new perspectives in the design of novel thermal therapies, and to optimize targeted temperature management strategies. This article is categorized under: Cardiovascular Diseases > Cardiovascular Diseases>Computational Models Cardiovascular Diseases > Cardiovascular Diseases>Environmental Factors Cardiovascular Diseases > Cardiovascular Diseases>Biomedical Engineering.
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Affiliation(s)
- Kristijan Skok
- Department of Pathology, General Hospital Graz II, Location West, Graz, Austria
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Maja Duh
- Faculty of Natural Sciences and Mathematics, University of Maribor, Koros̆ka cesta, Maribor, Slovenia
| | - Andraž Stožer
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Andrej Markota
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
- Medical Intensive Care Unit, University Medical Centre Maribor, Maribor, Slovenia
| | - Marko Gosak
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
- Faculty of Natural Sciences and Mathematics, University of Maribor, Koros̆ka cesta, Maribor, Slovenia
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Fever Characteristics and Risk of Serious Bacterial Infection in Febrile Infants. J Emerg Med 2019; 57:306-313. [PMID: 31400986 DOI: 10.1016/j.jemermed.2019.06.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 06/07/2019] [Accepted: 06/15/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Fever is a common complaint in the pediatric emergency department (ED), but the vast majority of children evaluated with fever do not have a serious bacterial infection (SBI). However, in the neonate, a missed SBI can have devastating consequences. OBJECTIVES To determine the association between various fever characteristics and the risk of SBI in febrile infants. METHODS This is a secondary analysis of the Pediatric Emergency Care Applied Research Network study on febrile infants. Infants with a fever were prospectively enrolled at 26 enrolling EDs between 2008 and 2013. We analyzed association of height of fever, location of where temperature was taken (enrolling ED vs. non-health care location), and duration of fever with SBI. RESULTS We included 4821 patients who had at least a blood culture completed. Height of fever was significantly associated with risk of SBI, with an odds ratio of 1.5 (95% confidence interval 1.2-1.8). Duration of fever was not associated with risk of SBI, and a fever taken in the enrolling ED vs. at a non-health care facility was minimally associated with risk of SBI (odds ratio 1.3, 95% confidence interval 1.0-1.5). CONCLUSION In all analyses, height of fever was associated with all three major types of SBI in febrile infants. Duration and location of fever were less reliably associated with risk of SBI, but there was a small association of risk of SBI and a fever taken at the enrolling ED vs. at a non-health care location.
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Nomura O, Ihara T, Sakakibara H, Hirokoshi Y, Inoue N. Predicting serious bacterial infection in febrile young infants utilizing body temperature. Pediatr Int 2019; 61:449-452. [PMID: 30859661 DOI: 10.1111/ped.13831] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 01/29/2019] [Accepted: 03/07/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Febrile young infants have a high risk of serious infection. Although measuring vital sign parameters can serve as a rapid and effective assessment in these patients, their predictive value for serious bacterial infection (SBI) has not been fully investigated. METHODS This retrospective observational study enrolled febrile (>38.0°C) infants aged <90 days at the time of presentation. Data from the emergency room triage database at Tokyo Metropolitan Children's Medical Center for the period 1 November 2011-30 November 2013, were reviewed. Variables included patient age, gender, and vital sign data, including body temperature, pulse rate, oxygen saturation, definitive diagnosis, and disposition. RESULTS Two hundred and sixty-nine patients were included, with a mean age of 55 days, and 158 (58.7%) were male. Of the total, 43 patients had an SBI. On logistic regression, body temperature ≥38.5°C (OR, 2.80; 95%CI: 1.37-5.74) was a significant predictor of SBI. CONCLUSION High-grade fever was found to be a significant predictor of SBI in febrile young infants.
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Affiliation(s)
- Osamu Nomura
- Division of Pediatric Emergency Medicine, Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Takateru Ihara
- Division of Pediatric Emergency Medicine, Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hiroshi Sakakibara
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yuho Hirokoshi
- Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.,Division of Immunology, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Nobuaki Inoue
- Division of Pediatric Emergency Medicine, Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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