Zhao Xiang Choa, Gayatiri Raveentheran, Zi Xean Khoo, Gene Yong-Kwang Ong, Lena Wong, Rupini Piragasam, Sashikumar Ganapathy, Shu-Ling Chong
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We compared SBI prevalence, performance of white blood cell (WBC), C-reactive protein (CRP), procalcitonin (PCT) and absolute neutrophil count (ANC), between infants with and without proven viral illness. We presented performance using sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>Among 1783 infants, 261 (14.6%) had SBIs, and 653 (36.6%) had proven viral infections. The prevalence of SBI was lower in infants with proven viral illness compared with those without (5.05% vs 20.2%, p<0.001, OR=0.211, 95% CI 0.144 to 0.308). In both groups, CRP >20 mg/L had the highest sensitivity (60.6%, 95% CI 42.1% to 77.1% and 67.0%, 95% CI 60.4% to 73.0% for those with proven illness and those without) and ANC >10×10<sup>9</sup>/L demonstrated the highest specificity (98.1%, 95% CI 96.7% to 99.1% and 93.1%, 95% CI 91.2% to 94.8%, for those with proven illness and those without), in predicting for SBIs. Using current thresholds, WBC, ANC, CRP and PCT performed with greater specificity but lower sensitivity among those with proven viral illness compared with those without. Differences in AUCs between both groups for the four inflammatory markers were only statistically significant with ANC >10×10<sup>9</sup>/L.</p><p><strong>Conclusions: </strong>Although febrile infants ≤90 days old with proven viral illnesses compared with those without were at lower risk of SBIs, current inflammatory markers thresholds may result in missed SBIs in this subgroup.</p><p><strong>Trial registration number: </strong>NCT04103151.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7000,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prevalence of serious bacterial infections and performance of inflammatory markers in febrile infants with and without proven viral illness.\",\"authors\":\"Zhao Xiang Choa, Gayatiri Raveentheran, Zi Xean Khoo, Gene Yong-Kwang Ong, Lena Wong, Rupini Piragasam, Sashikumar Ganapathy, Shu-Ling Chong\",\"doi\":\"10.1136/emermed-2024-214435\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Febrile infants ≤90 days old with proven viral infections who may have concurrent serious bacterial infections (SBIs) remain a diagnostic dilemma. 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引用次数: 0
摘要
背景：出生≤90天且证实病毒感染的发热婴儿可能并发严重细菌感染（sbi）仍然是一个诊断难题。我们的目的是比较sbi的患病率，并评估炎症标志物在预测有和没有病毒性疾病的婴儿之间sbi的表现。方法：我们对2017年12月1日至2022年7月31日期间在新加坡三级儿科急诊科就诊的年龄≤90天、体温≥38°C的发热婴儿进行了二次分析。我们比较了SBI患病率、白细胞（WBC）、c反应蛋白（CRP）、降钙素原（PCT）和绝对中性粒细胞计数（ANC）在有和没有病毒性疾病的婴儿之间的表现。我们通过灵敏度、特异性、阳性预测值和阴性预测值以及受试者工作特征曲线（AUC）下的面积来评价其性能。结果：在1783例婴儿中，261例（14.6%）有sbi， 653例（36.6%）有病毒感染。确诊为病毒性疾病的婴儿SBI患病率低于未确诊为病毒性疾病的婴儿（5.05% vs 20.2%）， p20 mg/L在预测SBI时灵敏度最高（60.6%,95% CI 42.1% ~ 77.1%和67.0%，确诊和未确诊为病毒性疾病的婴儿95% CI 60.4% ~ 73.0%）， ANC >10×109/L在确诊和未确诊为病毒性疾病的婴儿中特异性最高（98.1%,95% CI 96.7% ~ 99.1%和93.1%,95% CI 91.2% ~ 94.8%）。使用目前的阈值，WBC、ANC、CRP和PCT在证实有病毒性疾病的患者中具有更高的特异性，但与没有病毒性疾病的患者相比，敏感性较低。两组间四种炎症标志物的auc差异仅在ANC >10×109/L时具有统计学意义。结论：尽管与未确诊病毒性疾病的婴儿相比，出生≤90天的发热婴儿发生sbi的风险较低，但目前的炎症标志物阈值可能导致该亚组未发生sbi。试验注册号：NCT04103151。
Prevalence of serious bacterial infections and performance of inflammatory markers in febrile infants with and without proven viral illness.
Background: Febrile infants ≤90 days old with proven viral infections who may have concurrent serious bacterial infections (SBIs) remain a diagnostic dilemma. We aimed to compare the prevalence of SBIs and evaluate the performance of inflammatory markers in predicting SBIs, between infants with and without proven viral illness.
Methods: We conducted a secondary analysis of febrile infants ≤90 days old presenting with temperature ≥38°C to a tertiary paediatric emergency department in Singapore between 1 December 2017 and 31 July 2022. We compared SBI prevalence, performance of white blood cell (WBC), C-reactive protein (CRP), procalcitonin (PCT) and absolute neutrophil count (ANC), between infants with and without proven viral illness. We presented performance using sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curve (AUC).
Results: Among 1783 infants, 261 (14.6%) had SBIs, and 653 (36.6%) had proven viral infections. The prevalence of SBI was lower in infants with proven viral illness compared with those without (5.05% vs 20.2%, p<0.001, OR=0.211, 95% CI 0.144 to 0.308). In both groups, CRP >20 mg/L had the highest sensitivity (60.6%, 95% CI 42.1% to 77.1% and 67.0%, 95% CI 60.4% to 73.0% for those with proven illness and those without) and ANC >10×109/L demonstrated the highest specificity (98.1%, 95% CI 96.7% to 99.1% and 93.1%, 95% CI 91.2% to 94.8%, for those with proven illness and those without), in predicting for SBIs. Using current thresholds, WBC, ANC, CRP and PCT performed with greater specificity but lower sensitivity among those with proven viral illness compared with those without. Differences in AUCs between both groups for the four inflammatory markers were only statistically significant with ANC >10×109/L.
Conclusions: Although febrile infants ≤90 days old with proven viral illnesses compared with those without were at lower risk of SBIs, current inflammatory markers thresholds may result in missed SBIs in this subgroup.
期刊介绍：
The Emergency Medicine Journal is a leading international journal reporting developments and advances in emergency medicine and acute care. It has relevance to all specialties involved in the management of emergencies in the hospital and prehospital environment. Each issue contains editorials, reviews, original research, evidence based reviews, letters and more.
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