The Accuracy of the Yale Observation Scale Score and Unstructured Clinician Suspicion to Identify Febrile Infants Aged <=60 Days with Serious Bacterial Infections:

Objective: Fever is among most common causes of admission to hospital in childhood. In 20% of febrile infants and children, no focus can be identified by physical examination and this group is defined as “acute fever without a focus” (AFWF). Bacteremia (5%), and serious bacterial infection (15%) is determined in of children with AFWF. Clinical scales and laboratory tests are used to detect the risk of occult bacteremia and serious bacterial infection in children with AFWF This study aimed to determine relation between biochemical indicators and YALE Observation Scale, besides, rates of clinical scales and biochemical indicators predicting serious bacterial infections, in 3-36 months children with AFWF. Material and Methods: This study was performed prospectively, in 77 cases, between 3-36 months of AFWF. Low risk criteria was evaluated by performing YALE Observation Scale in children. Complete blood count, absolute neutrophil count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin 6, procalcitonin, urine analysis, chest x-ray, cerebrospinal fluid (CSF) examination; blood, urine and CSF cultures were obtained. Results: The mean age of the patients was 11.0 (4-36) months, 64.9% (n= 50) were boys. Most commonly AFWF recovered in patients (35.0%), and urinary tract infection was diagnosed (32.5%). Severe bacterial infection was determined in 44.2%. When patient groups with and without severe bacterial infection were compared, white blood count, ESH, CRP, and procalcitonin were significantly higher in severe bacterial infection (p< 0.05). Erythrocyte sedimentation rate had highest specificity (87.5%) in discriminating between groups with and without severe bacterial infection. Conclusion: In conclusion, AFWF mostly recovered in children at 3-36 months, and urinary tract infection was common cause. White cell count, ESR, CRP and procalcitonin were found valuable in predicting serious bacterial infection. Further studies are needed to predict interleukin-6 value relevant to serious bacterial infection.

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Assessment of the utility of Yale observation scale as a predictor of bacteremia in children aged 3 months to 36 months

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20190081 ◽

2019 ◽

Vol 6 (2) ◽

pp. 559

Author(s):

P. Sudhakar ◽

P. Ajitha

Keyword(s):

Bacterial Infections ◽

Clinical Signs ◽

Signs And Symptoms ◽

Roc Curves ◽

Operating Characteristics ◽

Good Tool ◽

Early Management ◽

Observation Scale ◽

Clinical Signs And Symptoms ◽

Yale Observation Scale

Background: The Yale observation scale (YOS) is an illness severity helps to diagnose bacteremia based on simple noninvasive clinical signs and symptoms. The aim of the present study was to assess the utility of YOS as a predictor of bacterial infection in febrile children aged 3 to 36 months.Methods: This prospective observational study was conducted on 200 children aged 3 to 36 months presenting with fever, at the Institute of Child Health and Hospital for Children during the period from April 2016 to September 2016. Rectal temperature was taken for all children. Clinical examination was done as required based on the YOS and scores were given accordingly at the time of initial presentation of the child before invasive investigations. All the observation was assessed statistically and receiver operating characteristics (ROC) curve was performed to analyze the sensitivity of the YOS.Results: Highly significant correlation (p=0.0001) was found to exist between the age of the child, duration of the fever, higher body temperature >104, WBC count, ANC and improved condition of patient with higher YOS. ROC curves showed that the sensitivity and specificity of YOS at the best cut off value of 14.5 was found to be 97% and 79.6% respectively.Conclusions: YOS is very good tool for predicting bacteremia in young febrile children based on simple non-invasive clinical signs and symptoms. The findings ruled out by YOS aids in the immediate and early management of bacterial infections before the arrival of the results of the biochemical diagnostic tests.

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Fever without a focus in children 0-36 months of age

Medicinski pregled ◽

10.2298/mpns0604187k ◽

2006 ◽

Vol 59 (3-4) ◽

pp. 187-191 ◽

Cited By ~ 2

Author(s):

Svetlana Kuzmanovic ◽

Nevenka Roncevic ◽

Aleksandra Stojadinovic

Keyword(s):

Antibiotic Therapy ◽

Bacterial Infection ◽

Medical Care ◽

Bacterial Infections ◽

Clinical Presentation ◽

Febrile Illness ◽

Empirical Antibiotic Therapy ◽

Focus Of Infection ◽

Serious Bacterial Infections ◽

Yale Observation Scale

Introduction. About 20% of fevers in childhood have no apparent cause. A small, but significant number of these children may have a seroius bacterial infection. Fever without a focus of infection is an acute febrile illness with rectal temperature of 38?C or higher in children younger than 36 months, without localizing signs or symptoms. Practice Guidelines for Medical Care. In this article, practical recommendations for medical care of febrile children 0-36 months of age are given, bearing in mind children's age, clinical presentation (toxic manifestations) and risk for serious bacterial infection (sepsis, meningitis, pneumonia, urinary tract infection...). Toxic appearance is a clinical presentation characterized by lethargy, poor perfusion, marked hypo/hyperventilation and cyanosis. All febrile children under 36 months of age, who are appearing toxic, require hospitalization, evaluation for sepsis and administration of empirical antibiotic therapy. All febrile neonates, however, must be hospitalized: cultures of blood, urine and spinal fluid should be taken and empirical antibiotic therapy administered immediately. Febrile infants, 28 to 90 days of age, need to be evaluated in order to determine whether they are in the low-risk group for serious bacterial infections (Rochester Criteria). Yale Observation Scale is recommended to assess febrile children aged 3-36 months, and the risk of occult bacteriemia. Febrile children, 3-36 months of age who appear well, with temperature of less than 39?C without focus, should be closely followed up without laboratory tests and antibiotics and 2-3 days later reexamined. In febrile children, 3-36 months old, with temperature of 39?C and above, without toxic manifestations, blood culture should be taken and ceftriaxone 50 mg/kg/in a single dose should be given, if leukocyte count is 15000/mm? or absolute neutrophil count is over 10.000/mm? .

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ROLE OF PARENTAL OBSERVATIONS IN EARLY DIAGNOSIS OF SERIOUS BACTERIAL INFECTIONS IN CHILDREN WITH FEVER ADMITTED TO THE HOSPITAL: A SEMI-QUALITATIVE PILOT STUDY

10.26226/morressier.58fa176ad462b80290b51da4 ◽

2017 ◽

Author(s):

Urzula Urbane

Keyword(s):

Pilot Study ◽

Early Diagnosis ◽

Bacterial Infections ◽

Serious Bacterial Infections

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#53: High Burden of Serious Bacterial Infections in African Children Treated for Cancer

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa170.019 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

pp. S6-S6

Author(s):

G Naidu ◽

A Izu ◽

R Wainwright ◽

S Poyiadjis ◽

D MacKinnon ◽

...

Keyword(s):

Bacterial Infections ◽

Case Fatality ◽

Morbidity And Mortality ◽

Coagulase Negative Staphylococci ◽

Children With Cancer ◽

Indwelling Catheter ◽

High Burden ◽

African Children ◽

Serious Bacterial Infections ◽

Living With Hiv

Abstract Background Infectious complications in children treated for cancer contribute to their morbidity and mortality. There is a paucity of studies on the incidence, microbiological etiology, risk factors, and outcome of serious bacterial infections in African children treated for cancer. Aim The aim of the study was to delineate the epidemiology of infectious morbidity and mortality in South African children with cancer. Methods This prospective, single-center, longitudinal-cohort study enrolled children one-19 years old hospitalized for cancer treatment at the Paediatric Oncology Unit, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa. Children were investigated for infection as part of the standard of care. Results In total, 169 children were enrolled, 82 with hematological malignancy (HM), 87 with a solid tumor (ST), median age was 68.5 months and 10.7% were living with HIV. The incidence (per 100 child-years) of septic episodes (SE) and microbiologically confirmed SE (MSCE) was 101 (138 vs. 70, P < 0.001) and 70.9 (99.1 vs. 47.3; P < 0.001), respectively; higher in children with HM than ST. The incidence of MCSE in children with high-risk HM (137.7) was 4.32-fold greater compared with those with medium-risk HM (30.3; P < 0.001). Children with metastatic ST had a higher incidence (84.4) of MSCE than those with localized ST (33.6; aOR: 2.52; P < 0.001). The presence of an indwelling catheter was 3-fold (P < 0.001) more likely to be associated with MCSE compared with those without. There was no association for age group, nutritional status or HIV-status, and incidence of MCSE. The incidence of gram-positive (GPB) and gram-negative (GNB) SEs was 48.5 and 37.6, respectively, and higher in children with an HM. The most commonly identified GPB were Coagulase-negative Staphylococci, Streptococcus viridans and Enterococcus faecium; while the most common GNB were Escherichia coli, Acinetobacter baumannii, and Pseudomonas species. The median CRP was higher in children with MSCE compared with those with culture-negative SE (CNSE) (116.5 vs. 92; P < 0.001) in both HM (132.5 vs. 117; P < 0.001) and ST (87.5 vs. 46; P < 0.001). The procalcitonin was higher in those with MSCE compared with those with CNSE (2.30 vs. 1.40; P < 0.001) in both HM (2.95 vs. 1.60; P = 0.002) and ST (2.10 vs. 1.20; P < 0.001). The case fatality risk was 40.4%; 80% was attributed to sepsis. Of these, 35 (72.92%) had HM and 34 of the 35 (97.14%) had HR-HM. Children with HM had an overall sepsis CFR of 42.68%. Four (30.77%) of the 13 sepsis-related deaths in STs had metastatic disease and 8 (16.67%) of the total number of sepsis-related deaths were in children living with HIV. There was no association between malnutrition or HIV-positivity and death. The odds of dying from sepsis were higher in children with profound (aOR 3.96; P = 0.004) and prolonged (aOR 3.71; P = 0.011) neutropenia. Pneumonia (58.85% vs. 29.23%; aOR 2.38; P = 0.025) and tuberculosis (70.83% vs. 34.91%; aOR 4.3; P = 0.005) were independently associated with a higher CFR. Conclusion The current study emphasizes the high burden of sepsis in African children treated for cancer, and especially HM, and highlights the association of tuberculosis and pneumonia as independent predictors of death in children with cancer.

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Age and sex‐specific prevalence of serious bacterial infections in febrile infants ≤60 days, in Sweden

Acta Paediatrica ◽

10.1111/apa.16043 ◽

2021 ◽

Author(s):

Ioannis Orfanos ◽

Tobias Alfvén ◽

Maria Mossberg ◽

Mattias Tenland ◽

Jorge Sotoca Fernandez ◽

...

Keyword(s):

Bacterial Infections ◽

Serious Bacterial Infections ◽

Age And Sex

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Assessment of the microbiome during bacteriophage therapy in combination with systemic antibiotics to treat a case of staphylococcal device infection

Microbiome ◽

10.1186/s40168-021-01026-9 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Andre Mu ◽

Daniel McDonald ◽

Alan K. Jarmusch ◽

Cameron Martino ◽

Caitriona Brennan ◽

...

Keyword(s):

Bacterial Infections ◽

Phage Therapy ◽

Ecological Impacts ◽

Skin Microbiome ◽

Bacteriophage Therapy ◽

Bacterial Diseases ◽

Device Infection ◽

Global Health Issue ◽

Serious Bacterial Infections ◽

Systemic Antibiotics

Abstract Background Infectious bacterial diseases exhibiting increasing resistance to antibiotics are a serious global health issue. Bacteriophage therapy is an anti-microbial alternative to treat patients with serious bacterial infections. However, the impacts to the host microbiome in response to clinical use of phage therapy are not well understood. Results Our paper demonstrates a largely unchanged microbiota profile during 4 weeks of phage therapy when added to systemic antibiotics in a single patient with Staphylococcus aureus device infection. Metabolomic analyses suggest potential indirect cascading ecological impacts to the host (skin) microbiome. We did not detect genomes of the three phages used to treat the patient in metagenomic samples taken from saliva, stool, and skin; however, phages were detected using endpoint-PCR in patient serum. Conclusion Results from our proof-of-principal study supports the use of bacteriophages as a microbiome-sparing approach to treat bacterial infections.

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