Rule out Sepsis in Infant

Acute Care Casebook ◽

10.1093/med/9780190865412.003.0052 ◽

2018 ◽

pp. 257-262

Author(s):

Temima Waltuch

Keyword(s):

Risk Stratification ◽

Lumbar Puncture ◽

Antibiotic Treatment ◽

Bacterial Infections ◽

Individual Risk ◽

Immune Systems ◽

Increased Risk ◽

Empiric Antibiotic ◽

Empiric Antibiotic Treatment ◽

Serious Bacterial Infections

This case reviews the workup and management of febrile infants less than 3 months of age. These infants are a unique population as their immune systems are immature, placing them at increased risk for serious bacterial infections. Most febrile infants have self-limited viral illnesses; however, it is important to identify those that have a coexisting or isolated bacterial illness. Febrile infants <28 days require a full sepsis workup and admission to the hospital for monitoring and parenteral empiric antibiotic treatment. Workup and management of febrile infants between 29 and 90 days present more of a controversy in the literature. At minimum, infants 1 to 2 months of age will have blood and urine cultures performed, while the lumbar puncture is dependent on their individual risk stratification. Workup for infants 2 to 3 months of age will be completely dependent on risk stratification.

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Fever in the Young Infant

Pediatric Emergencies ◽

10.1093/med/9780190073879.003.0009 ◽

2020 ◽

pp. 75-81

Author(s):

Paul Ishimine

Keyword(s):

Bacterial Infections ◽

Young Infant ◽

Diagnostic Testing ◽

Screening Tests ◽

Empiric Antibiotic ◽

Bacterial Gastroenteritis ◽

Empiric Antibiotic Treatment ◽

Serious Bacterial Infections ◽

Tract Infections ◽

Urine Testing

Fever is the most common complaint of children who present to the emergency department. Approximately 12% of febrile neonates (aged 0–28 days) and young infants (aged 29—56 days) have serious bacterial infections (bacteremia, meningitis, urinary tract infections, pneumonia, bacterial gastroenteritis, and osteomyelitis). The evaluation and management of the febrile neonate and febrile young infant can be confusing. All febrile neonates require diagnostic testing, treatment with antibiotics, and hospital admission. The workup of the febrile young infant is more controversial. These patients should undergo blood and urine testing, but the need for lumbar puncture is controversial, as is the need for empiric antibiotic treatment. The disposition of these patients will depend on the results of these screening tests.

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Factors associated with increased risk of inappropriate empiric antibiotic treatment of childhood bacteraemia

European Journal of Pediatrics ◽

10.1007/bf01957902 ◽

1996 ◽

Vol 155 (7) ◽

pp. 545-550 ◽

Cited By ~ 7

Author(s):

Shai Ashkenazi ◽

Zmira Samra ◽

Hana Konisberger ◽

Moshe M. Drucker ◽

Leonard Leibovici

Keyword(s):

Antibiotic Treatment ◽

Factors Associated ◽

Increased Risk ◽

Empiric Antibiotic ◽

Empiric Antibiotic Treatment

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Factors associated with increased risk of inappropriate empiric antibiotic treatment of childhood bacteraemia

European Journal of Pediatrics ◽

10.1007/s004310050439 ◽

1996 ◽

Vol 155 (7) ◽

pp. 545-550

Author(s):

Shai Ashkenazi ◽

Zmira Samra ◽

Hana Konisberger ◽

Moshe M. Drucker ◽

Leonard Leibovici

Keyword(s):

Antibiotic Treatment ◽

Factors Associated ◽

Increased Risk ◽

Empiric Antibiotic ◽

Empiric Antibiotic Treatment

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Empiric antibiotic treatment of acute bacterial infections of the lower respiratory tract in children in an era of changing etiology

Pediatric Pulmonology ◽

10.1002/ppul.1950191108 ◽

1995 ◽

Vol 19 (S11) ◽

pp. 12-13 ◽

Cited By ~ 1

Author(s):

Michael E. Pichichero

Keyword(s):

Respiratory Tract ◽

Antibiotic Treatment ◽

Lower Respiratory Tract ◽

Bacterial Infections ◽

Empiric Antibiotic ◽

Empiric Antibiotic Treatment ◽

Acute Bacterial Infections

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Empiric Antibiotic Treatment Thresholds for Serious Bacterial Infections: A Scenario-based Survey Study

Clinical Infectious Diseases ◽

10.1093/cid/ciy1031 ◽

2018 ◽

Vol 69 (6) ◽

pp. 930-937 ◽

Cited By ~ 10

Author(s):

Alex M Cressman ◽

Derek R MacFadden ◽

Amol A Verma ◽

Fahad Razak ◽

Nick Daneman

Keyword(s):

Bacterial Infections ◽

Survey Study ◽

Antibiotic Prescribing ◽

Antibiotic Regimen ◽

Empiric Antibiotic ◽

Infection Source ◽

Empiric Antibiotic Treatment ◽

Serious Bacterial Infections ◽

Qsofa Score ◽

Attending Physicians

Abstract Background Physicians face competing demands of maximizing pathogen coverage while minimizing unnecessary use of broad-spectrum antibiotics when managing sepsis. We sought to identify physicians’ perceived likelihood of coverage achieved by their usual empiric antibiotic regimen, along with minimum thresholds of coverage they would be willing to accept when managing these patients. Methods We conducted a scenario-based survey of internal medicine physicians from across Canada using a 2 × 2 factorial design, varied by infection source (undifferentiated vs genitourinary) and severity (mild vs severe) denoted by the Quick Sequential Organ Failure Assessment (qSOFA) score. For each scenario, participants selected their preferred empiric antibiotic regimen, estimated the likelihood of coverage achieved by that regimen, and considered their minimum threshold of coverage. Results We had 238 respondents: 87 (36.6%) residents and 151 attending physicians (63.4%). The perceived likelihood of antibiotic coverage and minimum thresholds of coverage (with interquartile range) for each scenario were as follows: (1) severe undifferentiated, 90% (89.5%–95.0%) and 90% (80%–95%), respectively; (2) mild undifferentiated, 89% (80%–95%) and 80% (70%–89.5%); (3) severe genitourinary, 91% (87.3%–95.0%) and 90% (80.0%–90.0%); and (4) mild genitourinary, 90% (81.8%–91.3%) and 80% (71.8%–90%). Illness severity and infectious disease specialty predicted higher thresholds of coverage whereas less clinical experience and lower self-reported prescribing intensity predicted lower thresholds of coverage. Conclusions Pathogen coverage of 80% and 90% are physician-acceptable thresholds for managing patients with mild and severe sepsis from bacterial infections. These data may inform clinical guidelines and decision-support tools to improve empiric antibiotic prescribing.

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