Summary
Fever in infants under three months old: incidence of potentially serious bacterial infection and the usefulness of rapid diagnostic tests
Affiliation of the authors
DOI
Quote
Gargallo Burriel E, Ricart Campos S, García García JJ, Garrido Romero R, Muñoz Almagro C, Gené Giralt A, et al. Fever in infants under three months old: incidence of potentially serious bacterial infection and the usefulness of rapid diagnostic tests. Emergencias. 2007;19:173-9
Summary
Aims:To assess the incidence and aetiology of potentially serious
bacterial disease (PSBD), viral infection and viral-bacterial coinfection
in a sample of febrile infants aged less than three
months.
Methods: Prospective study of infants aged less than three months admitted
to our hospital because of fever. A complete sepsis study was
performed in all cases, with lumbar tap in selected cases. PSBD is defined
as the growth of bacteria in blood, urine or cebrospinal fluid
(CSF). The presence of Respiratory Syncitial Virus and of influenza A
and B viruses was assessed during the epidemic period, and enteroviruses
were investigated using the polymerase chain reaction in eleven
patients aged less than one month. The SPSS 12.0 software was used
for the analysis.
Results: The study population comprised 136 infants aged less than three
months. Seventy patients (51.5%) met the Rochester low-risk criteria.
The most common final diagnoses were non-focal febrile syndrome
and urinary infection. PSBD was demonstrated in 33 cases (24.3%)
(31 urine cultures, 2 CSF cultures and 7 blood cultures were positive).
The incidence of documented viral infection was 30.8%. Viral and bacterial
coinfection was demonstrated in 2 cases (4.8% of the total number
of virus-infected patients). Enterovirus was demonstrated in the
CSF in 5 (45.5%) of 11 cases studied; none of them had positive bacterial
cultures.
Discussion: In the present study, urinary infection was the most frequently
occurring potentially serious bacterial disease, with an incidence
higher than those reported in other series. The inclusion of rapid virological
diagnostic tests in the diagnostic algorithms helps in selecting
those infants with lower risk of bacterial infection and opens new perspectives
for the management of febrile infants aged less than three
months.