FeBRILe3: Risk-Stratification and Diagnosis of Serious Bacterial Infections in Febrile Infants Less Than 3 Months Old

IF 1.6 4区医学 Q2 PEDIATRICS

Journal of paediatrics and child health Pub Date : 2025-03-28 DOI:10.1111/jpc.70041

Ariel O. Mace, Jessica Ramsay, James Totterdell, Andrew C. Martin, Julie Barnett, Jade Ferullo, Briony Hazelton, Paul Ingram, Julie A. Marsh, Peter Richmond, Yue Wu, Thomas L. Snelling

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引用次数: 0

Abstract

Objectives

Evidence-based recommendations exist for early discharge (before 48 h) of young infants with fever without source (FWS) at low risk of serious bacterial infections (SBIs). However, concerns regarding the applicability of international data to local contexts may hinder implementation. We aimed to describe the local epidemiology of FWS and evaluate a newly implemented risk-stratification guideline to support practice change.

Methods

Prospective observational study of infants aged < 3 months admitted for investigation and management of FWS to two hospitals in Perth, Western Australia following implementation of an FWS risk-stratification guideline (August 2019–December 2021). We assessed the risk-stratification rule performance and determined the positive/negative likelihood ratios of individual patient characteristics for predicting SBI diagnosis.

Results

Five hundred infants were enrolled in the study cohort (median age 34 days, 36% female). SBI was diagnosed in 159 infants (32%), including urinary tract infection (n = 140), bacteraemia (n = 18) and bacterial meningitis (n = 9). Viruses were detected in 174 out of 406 tested infants (43%). Seventy-one infants met low-risk criteria (14%); only 69 out of 360 infants without SBI were classified as low risk (19%). The risk-stratification criteria demonstrated 99% sensitivity and 97% negative predictive value for SBI diagnosis, but only 21% specificity. Patient characteristics associated with a reduced likelihood of SBI diagnosis included female sex, sick contact exposure and virus detection.

Conclusions

Meeting the low-risk criteria successfully excluded most infants with SBI; however, only a small proportion of infants without SBI fulfilled these criteria. Integrating additional patient characteristics into updated risk-stratification algorithms may improve the predictive value of future prediction tools.

Trial Registration

Australia and New Zealand Clinical Trials Register (ACTRN12619001010189)

查看原文本刊更多论文

未满3个月发热婴儿严重细菌感染的风险分层和诊断。

目的：对于低风险严重细菌感染（SBIs）的无源发热（FWS）婴儿早期出院（48小时前）存在循证建议。但是，对国际数据是否适用于当地情况的关切可能会妨碍执行。我们的目的是描述FWS的当地流行病学，并评估新实施的风险分层指南，以支持实践变革。结果：500名婴儿被纳入研究队列（中位年龄34天，36%为女性）。159例（32%）婴儿被诊断为SBI，包括尿路感染（n = 140）、菌血症（n = 18）和细菌性脑膜炎（n = 9）。在406名接受检测的婴儿中，有174名（43%）被检测出病毒。71名婴儿符合低风险标准（14%）；360名没有SBI的婴儿中只有69名被归为低风险（19%）。风险分层标准对SBI诊断的敏感性为99%，阴性预测值为97%，特异性仅为21%。与SBI诊断可能性降低相关的患者特征包括女性、患病接触暴露和病毒检测。结论：符合低危标准成功排除了大多数SBI婴儿；然而，只有一小部分没有SBI的婴儿符合这些标准。将额外的患者特征整合到更新的风险分层算法中可能会提高未来预测工具的预测价值。试验注册：澳大利亚和新西兰临床试验注册（ACTRN12619001010189）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of paediatrics and child health 医学-小儿科

CiteScore

2.90

自引率

5.90%

发文量

487

审稿时长

3-6 weeks

期刊介绍： The Journal of Paediatrics and Child Health publishes original research articles of scientific excellence in paediatrics and child health. Research Articles, Case Reports and Letters to the Editor are published, together with invited Reviews, Annotations, Editorial Comments and manuscripts of educational interest.