1
|
Westphal K, Adib H, Doraiswamy V, Basiago K, Lee J, Banker SL, Morrison J, McCartor S, Berger S, Schmit EO, Van Meurs A, Mitchell M, Lee C, Wood JK, Tapp LG, Kunkel D, Halvorson EE, Potisek NM. Performance of Febrile Infant Decision Tools on Hypothermic Infants Evaluated for Infection. Hosp Pediatr 2024; 14:163-171. [PMID: 38312006 DOI: 10.1542/hpeds.2023-007525] [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: 02/06/2024]
Abstract
BACKGROUND Given the lack of evidence-based guidelines for hypothermic infants, providers may be inclined to use febrile infant decision-making tools to guide management decisions. Our objective was to assess the diagnostic performance of febrile infant decision tools for identifying hypothermic infants at low risk of bacterial infection. METHODS We conducted a secondary analysis of a retrospective cohort study of hypothermic (≤36.0 C) infants ≤90 days of age presenting to the emergency department or inpatient unit among 9 participating sites between September 1, 2016 and May 5, 2021. Well-appearing infants evaluated for bacterial infections via laboratory testing were included. Infants with complex chronic conditions or premature birth were excluded. Performance characteristics for detecting serious bacterial infection (SBI; urinary tract infection, bacteremia, bacterial meningitis) and invasive bacterial infection (IBI; bacteremia, bacterial meningitis) were calculated for each tool. RESULTS Overall, 314 infants met the general inclusion criteria, including 14 cases of SBI (4.5%) and 7 cases of IBI (2.2%). The median age was 5 days, and 68.1% of the infants (214/314) underwent a full sepsis evaluation. The Philadelphia, Boston, IBI Score, and American Academy of Pediatrics Clinical Practice Guideline did not misclassify any SBI or IBI as low risk; however, they had low specificity and positive predictive value. Rochester and Pediatric Emergency Care Applied Research Network tools misclassified infants with bacterial infections. CONCLUSIONS Several febrile infant decision tools were highly sensitive, minimizing missed SBIs and IBIs in hypothermic infants. However, the low specificity of these decision tools may lead to unnecessary testing, antimicrobial exposure, and hospitalization.
Collapse
Affiliation(s)
- Kathryn Westphal
- Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Hania Adib
- Department of Pediatrics, Keck School of Medicine of USC, Children's Hospital Los Angeles, Los Angeles, California
| | - Vignesh Doraiswamy
- Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Kevin Basiago
- Department of Pediatrics, Keck School of Medicine of USC, Children's Hospital Los Angeles, Los Angeles, California
| | - Jennifer Lee
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, New York
| | - Sumeet L Banker
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, New York
| | - John Morrison
- Division of Pediatric Hospital Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Saylor McCartor
- Department of Pediatrics, University of South Carolina School of Medicine Greenville, Prisma Health Children's Hospital-Upstate, Greenville, South Carolina
| | - Stephanie Berger
- Department of Pediatrics, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Erinn O Schmit
- Department of Pediatrics, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Annalise Van Meurs
- Department of Pediatrics, Oregon Health and Science University, Doernbecher Children's Hospital, Portland, Oregon
| | - Meredith Mitchell
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Clifton Lee
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Julie K Wood
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Lauren G Tapp
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Deborah Kunkel
- School of Mathematical and Statistical Sciences, Clemson University, Clemson, South Carolina
| | - Elizabeth E Halvorson
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Nicholas M Potisek
- Department of Pediatrics, University of South Carolina School of Medicine Greenville, Prisma Health Children's Hospital-Upstate, Greenville, South Carolina
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
2
|
Potisek NM, Morrison J, St Ville ME, Westphal K, Wood JK, Lee J, Combs MD, Berger S, Lee C, Van Meurs A, Halvorson EE. Time to Positive Blood and Cerebrospinal Fluid Cultures in Hypothermic Young Infants. Hosp Pediatr 2024; 14:e6-e12. [PMID: 38062772 DOI: 10.1542/hpeds.2023-007391] [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: 01/02/2024]
Abstract
BACKGROUND AND OBJECTIVE Hypothermia in young infants may be secondary to an invasive bacterial infection. No studies have explored culture time-to-positivity (TTP) in hypothermic infants. Our objective was to compare TTP of blood and cerebrospinal fluid (CSF) cultures between pathogenic and contaminant bacteria in hypothermic infants ≤90 days of age. METHODS Secondary analysis of a retrospective cohort of 9 children's hospitals. Infants ≤90 days of age presenting to the emergency department or inpatient setting with hypothermia from September 1, 2017, to May 5, 2021, with positive blood or CSF cultures were included. Differences in continuous variables between pathogenic and contaminant organism groups were tested using a 2-sample t test and 95% confidence intervals for the mean differences reported. RESULTS Seventy-seven infants met inclusion criteria. Seventy-one blood cultures were positive, with 20 (28.2%) treated as pathogenic organisms. Five (50%) of 10 positive CSF cultures were treated as pathogenic. The median (interquartile range [IQR]) TTP for pathogenic blood cultures was 16.8 (IQR 12.7-19.2) hours compared with 26.11 (IQR 20.5-48.1) hours for contaminant organisms (P < .001). The median TTP for pathogenic organisms on CSF cultures was 34.3 (IQR 2.0-53.7) hours, compared with 58.1 (IQR 52-72) hours for contaminant CSF organisms (P < .186). CONCLUSIONS Our study is the first to compare the TTP of blood and CSF cultures between pathogenic and contaminant bacteria in hypothermic infants. All pathogenic bacteria in the blood grew within 36 hours. No difference in TTP of CSF cultures between pathogenic and contaminant bacteria was detected.
Collapse
Affiliation(s)
- Nicholas M Potisek
- Department of Pediatrics, University of South Carolina School of Medicine Greenville, Prisma Health Children's Hospital-Upstate, Greenville, South Carolina
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - John Morrison
- Division of Pediatric Hospital Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Kathryn Westphal
- Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Julie K Wood
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jennifer Lee
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, New York
| | - Monica D Combs
- Department of Pediatrics, Keck School of Medicine of USC, Children's Hospital Los Angeles, Los Angeles, California
| | - Stephanie Berger
- Department of Pediatrics, University of Alabama Heersink School of Medicine, Birmingham, Alabama
| | - Clifton Lee
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Annalise Van Meurs
- Department of Pediatrics, Oregon Health and Science University, Doernbecher Children's Hospital, Portland, Oregon
| | - Elizabeth E Halvorson
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|