Weekly Article: Infant Fevers

Originally sent by Eiman

I chose another article on fever in young infants (Naomi had reviewed a retrospective study a few weeks ago). 

This is a systematic review published in 2010 that looked at studies on low risk criteria for serious bacterial illnesses (SBI) in <90 day olds.  They categorized the studies into prospective (with antibiotics treatment for all infant) vs prospective (antibiotics withheld) vs retrospective and compared the rate of SBI in those low-risk patients in each category.

Table 3 shows the prospective studies where antibiotics were held, which found 6 cases of SBI in 870 cases total categorized as low risk.  Rate of 0.67%

Table 4 shows prospective studies where empiric antibiotics was given for all patients. Here there were 57 cases of SBI missed /2012  low risk patients with a rate of 2.71%

Table 5 shows retrospective studies which found 32 missed cases of SBI /1102 low risk patients with a rate of 2.7%

The authors hypothesize that the low risk criteria will work if careful application of these low risk criterias was applied with observation alone.  In the “missed” 6 cases noted in table 3, the majority had UTI (4patients) and 2 patients had bacteremia.  All patients were treated with antibiotics when cultures were found to be positive.

Overall, this is a comprehensive review of the literature that looked at the effectiveness of low risk criteria and they are hypothesizing that when applied prospectively “… clinicians should be confident in withholding empiric antibiotic treatment.”

 I didn't look at all the missed SBI cases in table 4 and 5 to see what percentage were UTI vs bacteremia vs meningitis. Would knowing that there were no meningitis cases missed make you comfortable not getting LPs and observe outpatient or inpatient in 1-2month olds?

Huppler, AR et al. Performance of Low-Risk Criteria in the Evaluation of Young Infants With Fever: Review of the Literature. Pediatrics 2010.