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Keimyung Medical Journal 2016;35(2):89-97.
Published online December 19, 2016.
Pathogenic Etiology and Clinical Indictors of Bacterial Infectoin in Febrile Infants Aged Less than 3 Months: A Single Institute Stduy.
Ji Hyun Park, Ye Jee Shim, Dong Seok Kim, Jin Hyeok Choi, Kwang Jin Kwak, Heung Sik Kim
1Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea. yejeeshim@dsmc.or.kr
2Department of Emergency Medicine, Keimyung University School of Medicine, Daegu, Korea.
Abstract
To analyze the infectious causes and clinical symptoms of febrile infants aged less than 3 months presenting to a Pediatric Emergency Medical Center (PEMC) and to propose more efficient, evidence-based management and treatment. We conducted a retrospective study of 462 febrile infants aged less than 3 months who visited PEMC at Keimyung University Dongsan Medical Center from January 2015 to June 2016. Infants' sex, age, fever duration, and laboratory findings, including bacterial or viral pathogens, were recorded. To evaluate clinical signs, one point per sign was given for grunting, decreased activity, and the presence of cyanosis; total scores were compared between the bacterial infection (BI) and non-bacterial infection (NBI) groups. BI was diagnosed in 118 (25.5%) infants, and no BI was diagnosed in 344 (74.5%) infants. Escherichia coli was the most frequently isolated pathogen, accounting for 80.5% (n = 95) of all infections (n = 118). Statistically significant differences in sex, the duration of fever, sign scores, white blood cell count, neutrophil count, lymphocyte count, and C-reactive protein (CRP) level were found between the BI and NBI groups. The cut-off value for CRP was 1.445 mg/dL, with sensitivity and specificity values of 76.3% and 75.9%, respectively, in BI patients, as determined by the receiver operating characteristic curve. As more PEMCs are being built in Korea, hospital accessibility is better; thus, it may be possible to perform outpatient management of young, febrile infants aged younger than 3 months without antibiotics and lumbar puncture using individual sign scores and laboratory findings.
Key Words: Bacterial infections, C-reactive protein, Fever, Infants
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