Epidemiology of Bacteremia in Febrile Infants Aged 60 Days and Younger

Elizabeth C. Powell, Prashant V. Mahajan, Genie Roosevelt, John D. Hoyle, Rajender Gattu, Andrea T. Cruz, Alexander J. Rogers, Shireen M. Atabaki, David M. Jaffe, T. Charles Casper, Octavio Ramilo, Nathan Kuppermann

Research output: Contribution to journalArticle

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Abstract

Study objective: To describe the current epidemiology of bacteremia in febrile infants 60 days of age and younger in the Pediatric Emergency Care Applied Research Network (PECARN). Methods: We conducted a planned secondary analysis of a prospective observational study of febrile infants 60 days of age and younger presenting to any of 26 PECARN emergency departments (2008 to 2013) who had blood cultures obtained. We excluded infants with significant comorbidities or critically ill appearance. The primary outcome was prevalence of bacteremia. Results: Of 7,335 screened infants, 4,778 (65.1%) had blood cultures and were enrolled. Of these patients, 84 had bacteremia (1.8%; 95% confidence interval [CI] 1.4% to 2.2%). The prevalence of bacteremia in infants aged 28 days or younger (47/1,515) was 3.1% (95% CI 2.3% to 4.1%); in infants aged 29 to 60 days (37/3,246), 1.1% (95% CI 0.8% to 1.6%). Prevalence differed by week of age for infants 28 days of age and younger (0 to 7 days: 4/156, 2.6%; 8 to 14 days: 19/356, 5.3%; 15 to 21 days: 15/449, 3.3%; and 22 to 28 days: 9/554, 1.6%). The most common pathogens were Escherichia coli (39.3%; 95% CI 29.5% to 50.0%) and group B streptococcus (23.8%; 95% CI 16.0% to 33.9%). Bacterial meningitis occurred in 19 of 1,515 infants 28 days of age and younger (1.3%; 95% CI 0.8% to 2.0%) and 5 of 3,246 infants aged 29 to 60 days (0.2%; 95% CI 0.1% to 0.4%). Of 84 infants with bacteremia, 36 (42.9%; 95% CI 32.8% to 53.5%) had urinary tract infections (E coli 83%); 11 (13.1%; 95% CI 7.5% to 21.9%) had bacterial meningitis. Conclusion: The prevalence of bacteremia and meningitis among febrile infants 28 days of age and younger is high and exceeds that observed in infants aged 29 to 60 days. E coli and group B streptococcus are the most common bacterial pathogens.

Original languageEnglish (US)
JournalAnnals of Emergency Medicine
DOIs
StateAccepted/In press - 2017
Externally publishedYes

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Bacteremia
Epidemiology
Fever
Confidence Intervals
Bacterial Meningitides
Streptococcus agalactiae
Emergency Medical Services
Escherichia coli
Pediatrics
Meningitis
Research
Critical Illness
Urinary Tract Infections
Observational Studies
Hospital Emergency Service
Comorbidity
Prospective Studies

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Epidemiology of Bacteremia in Febrile Infants Aged 60 Days and Younger. / Powell, Elizabeth C.; Mahajan, Prashant V.; Roosevelt, Genie; Hoyle, John D.; Gattu, Rajender; Cruz, Andrea T.; Rogers, Alexander J.; Atabaki, Shireen M.; Jaffe, David M.; Casper, T. Charles; Ramilo, Octavio; Kuppermann, Nathan.

In: Annals of Emergency Medicine, 2017.

Research output: Contribution to journalArticle

Powell, EC, Mahajan, PV, Roosevelt, G, Hoyle, JD, Gattu, R, Cruz, AT, Rogers, AJ, Atabaki, SM, Jaffe, DM, Casper, TC, Ramilo, O & Kuppermann, N 2017, 'Epidemiology of Bacteremia in Febrile Infants Aged 60 Days and Younger', Annals of Emergency Medicine. https://doi.org/10.1016/j.annemergmed.2017.07.488
Powell, Elizabeth C. ; Mahajan, Prashant V. ; Roosevelt, Genie ; Hoyle, John D. ; Gattu, Rajender ; Cruz, Andrea T. ; Rogers, Alexander J. ; Atabaki, Shireen M. ; Jaffe, David M. ; Casper, T. Charles ; Ramilo, Octavio ; Kuppermann, Nathan. / Epidemiology of Bacteremia in Febrile Infants Aged 60 Days and Younger. In: Annals of Emergency Medicine. 2017.
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title = "Epidemiology of Bacteremia in Febrile Infants Aged 60 Days and Younger",
abstract = "Study objective: To describe the current epidemiology of bacteremia in febrile infants 60 days of age and younger in the Pediatric Emergency Care Applied Research Network (PECARN). Methods: We conducted a planned secondary analysis of a prospective observational study of febrile infants 60 days of age and younger presenting to any of 26 PECARN emergency departments (2008 to 2013) who had blood cultures obtained. We excluded infants with significant comorbidities or critically ill appearance. The primary outcome was prevalence of bacteremia. Results: Of 7,335 screened infants, 4,778 (65.1{\%}) had blood cultures and were enrolled. Of these patients, 84 had bacteremia (1.8{\%}; 95{\%} confidence interval [CI] 1.4{\%} to 2.2{\%}). The prevalence of bacteremia in infants aged 28 days or younger (47/1,515) was 3.1{\%} (95{\%} CI 2.3{\%} to 4.1{\%}); in infants aged 29 to 60 days (37/3,246), 1.1{\%} (95{\%} CI 0.8{\%} to 1.6{\%}). Prevalence differed by week of age for infants 28 days of age and younger (0 to 7 days: 4/156, 2.6{\%}; 8 to 14 days: 19/356, 5.3{\%}; 15 to 21 days: 15/449, 3.3{\%}; and 22 to 28 days: 9/554, 1.6{\%}). The most common pathogens were Escherichia coli (39.3{\%}; 95{\%} CI 29.5{\%} to 50.0{\%}) and group B streptococcus (23.8{\%}; 95{\%} CI 16.0{\%} to 33.9{\%}). Bacterial meningitis occurred in 19 of 1,515 infants 28 days of age and younger (1.3{\%}; 95{\%} CI 0.8{\%} to 2.0{\%}) and 5 of 3,246 infants aged 29 to 60 days (0.2{\%}; 95{\%} CI 0.1{\%} to 0.4{\%}). Of 84 infants with bacteremia, 36 (42.9{\%}; 95{\%} CI 32.8{\%} to 53.5{\%}) had urinary tract infections (E coli 83{\%}); 11 (13.1{\%}; 95{\%} CI 7.5{\%} to 21.9{\%}) had bacterial meningitis. Conclusion: The prevalence of bacteremia and meningitis among febrile infants 28 days of age and younger is high and exceeds that observed in infants aged 29 to 60 days. E coli and group B streptococcus are the most common bacterial pathogens.",
author = "Powell, {Elizabeth C.} and Mahajan, {Prashant V.} and Genie Roosevelt and Hoyle, {John D.} and Rajender Gattu and Cruz, {Andrea T.} and Rogers, {Alexander J.} and Atabaki, {Shireen M.} and Jaffe, {David M.} and Casper, {T. Charles} and Octavio Ramilo and Nathan Kuppermann",
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T1 - Epidemiology of Bacteremia in Febrile Infants Aged 60 Days and Younger

AU - Powell, Elizabeth C.

AU - Mahajan, Prashant V.

AU - Roosevelt, Genie

AU - Hoyle, John D.

AU - Gattu, Rajender

AU - Cruz, Andrea T.

AU - Rogers, Alexander J.

AU - Atabaki, Shireen M.

AU - Jaffe, David M.

AU - Casper, T. Charles

AU - Ramilo, Octavio

AU - Kuppermann, Nathan

PY - 2017

Y1 - 2017

N2 - Study objective: To describe the current epidemiology of bacteremia in febrile infants 60 days of age and younger in the Pediatric Emergency Care Applied Research Network (PECARN). Methods: We conducted a planned secondary analysis of a prospective observational study of febrile infants 60 days of age and younger presenting to any of 26 PECARN emergency departments (2008 to 2013) who had blood cultures obtained. We excluded infants with significant comorbidities or critically ill appearance. The primary outcome was prevalence of bacteremia. Results: Of 7,335 screened infants, 4,778 (65.1%) had blood cultures and were enrolled. Of these patients, 84 had bacteremia (1.8%; 95% confidence interval [CI] 1.4% to 2.2%). The prevalence of bacteremia in infants aged 28 days or younger (47/1,515) was 3.1% (95% CI 2.3% to 4.1%); in infants aged 29 to 60 days (37/3,246), 1.1% (95% CI 0.8% to 1.6%). Prevalence differed by week of age for infants 28 days of age and younger (0 to 7 days: 4/156, 2.6%; 8 to 14 days: 19/356, 5.3%; 15 to 21 days: 15/449, 3.3%; and 22 to 28 days: 9/554, 1.6%). The most common pathogens were Escherichia coli (39.3%; 95% CI 29.5% to 50.0%) and group B streptococcus (23.8%; 95% CI 16.0% to 33.9%). Bacterial meningitis occurred in 19 of 1,515 infants 28 days of age and younger (1.3%; 95% CI 0.8% to 2.0%) and 5 of 3,246 infants aged 29 to 60 days (0.2%; 95% CI 0.1% to 0.4%). Of 84 infants with bacteremia, 36 (42.9%; 95% CI 32.8% to 53.5%) had urinary tract infections (E coli 83%); 11 (13.1%; 95% CI 7.5% to 21.9%) had bacterial meningitis. Conclusion: The prevalence of bacteremia and meningitis among febrile infants 28 days of age and younger is high and exceeds that observed in infants aged 29 to 60 days. E coli and group B streptococcus are the most common bacterial pathogens.

AB - Study objective: To describe the current epidemiology of bacteremia in febrile infants 60 days of age and younger in the Pediatric Emergency Care Applied Research Network (PECARN). Methods: We conducted a planned secondary analysis of a prospective observational study of febrile infants 60 days of age and younger presenting to any of 26 PECARN emergency departments (2008 to 2013) who had blood cultures obtained. We excluded infants with significant comorbidities or critically ill appearance. The primary outcome was prevalence of bacteremia. Results: Of 7,335 screened infants, 4,778 (65.1%) had blood cultures and were enrolled. Of these patients, 84 had bacteremia (1.8%; 95% confidence interval [CI] 1.4% to 2.2%). The prevalence of bacteremia in infants aged 28 days or younger (47/1,515) was 3.1% (95% CI 2.3% to 4.1%); in infants aged 29 to 60 days (37/3,246), 1.1% (95% CI 0.8% to 1.6%). Prevalence differed by week of age for infants 28 days of age and younger (0 to 7 days: 4/156, 2.6%; 8 to 14 days: 19/356, 5.3%; 15 to 21 days: 15/449, 3.3%; and 22 to 28 days: 9/554, 1.6%). The most common pathogens were Escherichia coli (39.3%; 95% CI 29.5% to 50.0%) and group B streptococcus (23.8%; 95% CI 16.0% to 33.9%). Bacterial meningitis occurred in 19 of 1,515 infants 28 days of age and younger (1.3%; 95% CI 0.8% to 2.0%) and 5 of 3,246 infants aged 29 to 60 days (0.2%; 95% CI 0.1% to 0.4%). Of 84 infants with bacteremia, 36 (42.9%; 95% CI 32.8% to 53.5%) had urinary tract infections (E coli 83%); 11 (13.1%; 95% CI 7.5% to 21.9%) had bacterial meningitis. Conclusion: The prevalence of bacteremia and meningitis among febrile infants 28 days of age and younger is high and exceeds that observed in infants aged 29 to 60 days. E coli and group B streptococcus are the most common bacterial pathogens.

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