Febrile Infants at Low Risk for Serious Bacterial Infection—An Appraisal of the Rochester Criteria and Implications for Management

PEDIATRICS ◽  
1994 ◽  
Vol 94 (3) ◽  
pp. 390-396 ◽  
Author(s):  
Julie A. Jaskiewicz ◽  
Carol A. McCarthy ◽  
Amy C. Richardson ◽  
Kathleen C. White ◽  
Donna J. Fisher ◽  
...  
Keyword(s):  
Confidence Interval ◽  
High Power ◽  
Microscopic Examination ◽  
Bacterial Infections ◽  
Antimicrobial Agents ◽  
Low Risk ◽  
High Power Field ◽  
Urine Sediment ◽  
Predictive Values ◽  
Risk Criteria

Objective. Prospective studies were conducted to test the hypothesis that infants unlikely to have serious bacterial infections (SBI) can be accurately identified by low risk criteria. Methods. Febrile infants (rectal T ≥ 38°C) ≤60 days of age were considered at low risk for SBI if they met the following criteria: 1) appear well; 2) were previously healthy; 3) have no focal infection; 4) have WBC count 5.0-15.0 x 109 cells/L (5000-15 000/mm3), band form count≤ 1.5 x 109 cells/L (≤1500/mm3), ≤10 WBC per high power field on microscopic examination of spun urine sediment, and ≤5 WBC per high power field on microscopic examination of a stool smear (if diarrhea). The recommended evaluation included the culture of specimens of blood, cerebrospinal fluid, and urine for bacteria. Outcomes were determined. The negative predictive values of the low risk criteria for SBI and bacteremia were calculated. Results. Of 1057 eligible infants, 931 were well appearing, and, of these, 437 met the remaining low risk criteria. Five low risk infants had SBI including two infants with bacteremia. The negative predictive value of the low risk criteria was 98.9% (95% confidence interval, 97.2% to 99.6%) for SBI, and 99.5% (95% confidence interval, 98.2% to 99.9%) for bacteremia. Conclusions. These data confirm the ability of the low risk criteria to identify infants unlikely to have SBI. Infants who meet the low risk criteria can be carefully observed without administering antimicrobial agents.

Analysis of emergency department prediction tools in evaluating febrile young infants at risk for serious infections

2019 ◽  
pp. emermed-2018-208210 ◽  
Author(s):  
Sarah Hui Wen Yao ◽  
Gene Yong-Kwang Ong ◽  
Ian K Maconochie ◽  
Khai Pin Lee ◽  
Shu-Ling Chong
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Clinical Assessment ◽  
Low Risk ◽  
Assessment Tools ◽  
Predictive Values ◽  
Nice Guideline ◽  
Risk Criteria ◽  
Young Infants ◽  
Serious Infections

ObjectiveFebrile infants≤3 months old constitute a vulnerable group at risk of serious infections (SI). We aimed to (1) study the test performance of two clinical assessment tools—the National Institute for Health and Care Excellence (NICE) Traffic Light System and Severity Index Score (SIS) in predicting SI among all febrile young infants and (2) evaluate the performance of three low-risk criteria—the Rochester Criteria (RC), Philadelphia Criteria (PC) and Boston Criteria (BC) among well-looking febrile infants.MethodsA retrospective validation study was conducted. Serious illness included both bacterial and serious viral illness such as meningitis and encephalitis. We included febrile infants≤3 months old presenting to a paediatric emergency department in Singapore between March 2015 and February 2016. Infants were assigned to high-risk and low-risk groups for SI according to each of the five tools. We compared the performance of the NICE guideline and SIS at initial clinical assessment for all infants and the low-risk criteria—RC, PC and BC—among well-looking infants. We presented their performance using sensitivity, specificity, positive, negative predictive values and likelihood ratios.ResultsOf 1057 infants analysed, 326 (30.8%) were diagnosed with SI. The NICE guideline had an overall sensitivity of 93.3% (95% CI 90.0 to 95.7), while the SIS had a sensitivity of 79.1% (95% CI 74.3 to 83.4). The incidence of SI was similar among infants who were well-looking and those who were not. Among the low-risk criteria, the RC performed with the highest sensitivity in infants aged 0–28 days (98.2%, 95% CI 90.3% to 100.0%) and 29–60 days (92.4%, 95% CI 86.0% to 96.5%), while the PC performed best in infants aged 61–90 days (100.0%, 95% CI 95.4% to 100.0%).ConclusionsThe NICE guideline achieved high sensitivity in our study population, and the RC had the highest sensitivity in predicting for SI among well-appearing febrile infants. Prospective validation is required.

scholarly journals Using the Idexx SediVue Dx to predict the need for urine bacteriologic culture in cats

2021 ◽  
pp. 104063872110389
Author(s):  
Elisabeth Neubert ◽  
Karin Weber
Keyword(s):  
Bacterial Growth ◽  
High Power ◽  
Leukocyte Count ◽  
Urine Samples ◽  
High Power Field ◽  
Urine Sediment ◽  
Sediment Analysis ◽  
Accurate Detection ◽  
Culture Positive ◽  
Culture Negative

We analyzed urine samples from 191 cats for bacteriuria with an automated urine sediment analyzer (Idexx SediVue Dx), combined with image review by an observer, and compared to bacteriologic culture results. Sixty-nine samples were unambiguously assigned to be free of bacteria by the instrument and the observer, and no bacterial growth was detected. Twenty-seven samples were unambiguously assigned to have bacteriuria; 24 of these 27 samples were culture-positive. For these samples, bacteriuria was predicted with a sensitivity of 100% and a specificity of 96%. A clear assignment was not possible for 95 samples, 81 of which were culture-negative. Specificity dropped to 45% when all samples were considered. Using the automated leukocyte count to predict bacteriuria, sensitivity was 82% and specificity was 75%. Automated sediment analysis is faster and less observer-dependent than sediment analysis under a microscope, but accurate detection of bacteriuria remains difficult in a large proportion of samples. Bacteriuria was significantly associated with leukocyte count; the leukocyte count was >5/high power field in 82% of culture-positive samples.

Letter to the Editor

PEDIATRICS ◽  
1994 ◽  
Vol 93 (2) ◽  
pp. 347-348
Author(s):  
Nicholas Paul Kokx
Keyword(s):  
Blood Cell ◽  
Physical Examination ◽  
White Blood Cell ◽  
High Power ◽  
Low Risk ◽  
Outpatient Management ◽  
High Power Field ◽  
Letter To The Editor ◽  
Wbc Count

I would like the authors of the article "Guideline for Management of Fever Without Soource"1 to comment on the following questions, observations, and counter points: 1. How does the data in Table 1 on page 3 support option 2 (of Fig 2 on page 5) for outpatient management of "low-risk" infants 28 to 90 days old? Table 1 lists the risk for meningitis as 39/1000 for the toxic infant, and 5/1000 for low-risk infants (defined as previously healthy, nontoxic appearing febrile infants with a negative physical examination and a negative laboratory screen, ie, white blood cell (WBC) count >5000 and <15 000 with <1500 bands, a normal urinalysis, and <5 WBC/high-power field in stool if diarrhea is present).

scholarly journals Disease activity in eosinophilic esophagitis is associated with impaired esophageal barrier integrity

2017 ◽  
Vol 313 (3) ◽  
pp. G230-G238 ◽  
Author(s):  
Marijn J. Warners ◽  
Bram D. van Rhijn ◽  
Joanne Verheij ◽  
Andreas J. P. M. Smout ◽  
Albert J. Bredenoord
Keyword(s):  
Disease Activity ◽  
Eosinophilic Esophagitis ◽  
High Power ◽  
High Power Field ◽  
Predictive Values ◽  
Impedance Measurements ◽  
Barrier Integrity ◽  
Mucosal Integrity ◽  
Esophageal Eosinophilia ◽  
Active Disease

In eosinophilic esophagitis (EoE), the esophageal barrier integrity is impaired. Integrity can be assessed with different techniques. To assess the correlations between esophageal eosinophilia and various measures of mucosal integrity and to evaluate whether endoscopic impedance measurements can predict disease activity, endoscopies and mucosal integrity measurements were performed in adult EoE patients with active disease (≥15 eosinophils/high-power field) at baseline ( n = 32) and after fluticasone ( n = 15) and elemental dietary treatment ( n = 14) and in controls ( n = 19). Mucosal integrity was evaluated during endoscopy using electrical tissue spectroscopy (ETIS) measuring mucosal impedance and transepithelial electrical resistance (TER) and transepithelial molecule-flux through biopsy specimens in Ussing chambers. We included 61 measurements; 32 of patients at baseline and 29 after treatment, 3 patients dropped out. After treatment, 20 patients were in remission (≤15 eosinophils/high-power field) and these measurements were compared with 41 measurements of patients with active disease (at baseline or after failed treatment). All four mucosal integrity measures showed significant impairment in active EoE compared with remission. Eosinophilia was negatively correlated with ETIS and TER and positively with transepithelial molecule flux ( P ≤ 0.001). The optimal ETIS cutoff to predict disease activity was 6,000 Ω·m with a sensitivity of 79% [95% confidence interval (CI) 54–94%], specificity of 84% (95% CI 69–94%), positive predictive values of 89% (95% CI 77–95%) and negative predictive values of 71% (95% CI 54–84%). In EoE patients, markers of mucosal integrity correlate with esophageal eosinophilia. Additionally, endoscopic mucosal impedance measurements can predict disease activity. NEW & NOTEWORTHY In adult patients with eosinophilic esophagitis (EoE), the mucosal integrity, measured by making use of four different parameters, correlates strongly with esophageal eosinophilia. The accuracy of endoscopically measured mucosal impedance to distinguish active disease from remission was acceptable with moderate specificity and sensitivity. Mucosal impedance measurements can predict disease activity in adult EoE patients.

Hematuria

1994 ◽  
Vol 15 (3) ◽  
pp. 102-108
Author(s):  
Douglas S. Fitzwater ◽  
Robert J. Wyatt
Keyword(s):  
Differential Diagnosis ◽  
High Power ◽  
Microscopic Examination ◽  
Rapid Evaluation ◽  
High Power Field ◽  
Dipstick Test ◽  
Early Referral ◽  
Urinary Sediment ◽  
Counting Chamber ◽  
Clinically Significant

Hematunia occurs in approximately 1.5% of children. It is important in evaluating the patient who has hematuna to make sure that a positive dipstick test is accompanied by RBCs on the microscopic examination. Hematunia is defined by several parameters, the most common of which are 6 cells/cc of urine in a counting chamber or 2 cells per high-power field in a urinary sediment. Although the differential diagnosis for hematuria is extensive, the most important differentiating feature is the presence or absence of proteinuria. Those who have significant proteinunia deserve a rapid evaluation and early referral to a nephrologist. Those who do not have proteinunia should be followed and a step-wise evaluation performed. Finally, most patients who have asymptomatic microscopic hematunia do not have clinically significant glomenular pathology.

Outpatient management of children at low risk for bacterial meningitis

2018 ◽  
Vol 35 (6) ◽  
pp. 361-366 ◽  
Author(s):  
Silvia Garcia ◽  
Janire Echevarri ◽  
Eunate Arana-Arri ◽  
Mercedes Sota ◽  
Javier Benito ◽  
...  
Keyword(s):  
Bacterial Meningitis ◽  
Prospective Observational Study ◽  
Final Diagnosis ◽  
Low Risk ◽  
Clinical Deterioration ◽  
Outpatient Management ◽  
Predictive Values ◽  
Risk Criteria ◽  
Csf Pleocytosis ◽  
Primary Composite Outcome

ObjectiveTo determine the outcome of children aged 2–14 years with cerebrospinal fluid (CSF) pleocytosis and at very low risk for bacterial meningitis managed as outpatients without antibiotics.MethodsMulticentre, prospective, observational study conducted at nine Spanish paediatric EDs. Patients were diagnosed with meningitis based on clinical suspicion of meningitis and CSF pleocytosis when evaluated in the ED. Children between 2 and 14 years of age with pleocytosis and very low-risk criteria for bacterial meningitis (well appearing, Bacterial Meningitis Score (BMS)=0, procalcitonin (PCT)<0.5 ng/mL and observation without deterioration for less than 24 hours in the ED) were treated as outpatients without antibiotics pending CSF cultures. The primary composite outcome was a final diagnosis of bacterial meningitis or return to the ED for clinical deterioration.ResultsOf 182 children between 2 and 14 years old diagnosed with meningitis, 56 met the very low-risk criteria and 45 were managed as outpatients. None was diagnosed with bacterial meningitis or returned due to clinical deterioration. Another 31 patients with BMS=1 (due to a peripheral absolute neutrophil count (ANC)>10 000/mm3) and PCT <0.5 ng/mL were managed as outpatients, diagnosed with aseptic meningitis and did well. BMS using PCT had the same sensitivity but greater specificity than classic BMS.ConclusionsThis set of low-risk criteria appears safe for the outpatient management without antibiotics of children with CSF pleocytosis. Larger studies are needed to evaluate the predictive values of replacing peripheral ANC with PCT in the BMS.

scholarly journals Tissue eosinophilia: a morphological marker for assessing stromal invasion in squamous neoplasms of the larynx

2013 ◽  
Vol 3 (5) ◽  
pp. 374-378
Author(s):  
RR Bhatta ◽  
RC Adhikari ◽  
G Sayami
Keyword(s):  
High Power ◽  
Squamous Carcinoma ◽  
Tumour Invasion ◽  
Stromal Invasion ◽  
Diagnostic Challenge ◽  
High Power Field ◽  
Morphological Marker ◽  
Predictive Values ◽  
Tissue Eosinophilia ◽  
Eosinophil Counts

Background: The assessment of tumour invasion in squamous neoplasms of the larynx poses a diagnostic challenge, especially in small biopsies that are frequently sectioned tangentially. Eosinophilic infi ltration is thought to be an adjunctive criterion in determining tumour invasion. We investigated whether thresholds of eosinophilic infi ltration in laryngeal squamous neoplasms would aid in determining the presence of invasion. Materials and Methods: Fifty cases of invasive squamous carcinoma, preinvasive squamous neoplasms and benign squamous neoplasms were evaluated. The number of eosinophils per high power field and per 10 high power fields in the stroma adjacent to the neoplastic epithelium were counted and tabulated. For statistical purposes, the elevated eosinophils were defi ned and categorized as: focally and moderately elevated (5-9/HPF), focally and markedly elevated (>10/HPF), diffusely and moderately elevated (5- 19/10HPF), and diffusely and markedly increased (>20/10/HPF). Results: Eosinophil counts were elevated focally and/or diffusely more frequently in invasive squamous carcinoma than in noninvasive tumours. The increased eosinophil counts, specifically >10/HPF and >20/10HPF, were statistically significantly associated with stromal invasion. Greater than 10/HPF and >20/10HPF had sensitivity, specifi city and positive predictive values of 23%,100%, 100% and 11%,100% and 100% respectively. Cytology was able to diagnose 33 out of 36 malignant cases. Of 17 cases which were diagnosed as benign on cytology, 3 cases turned out to be malignant on biopsy. The sensitivity and specifi city of touch smear cytology are 91.6% and 100% respectively. Conclusion: The elevated eosinophil count in squamous neoplasms of larynx is a morphologic feature associated with presence of tumour invasion. When the number of infiltrating eosinophils exceeds 10/ HPF and or >20/10HPF in a laryngeal biopsy with squamous neoplasm, it represents an indicator for the possibility of tumour invasion. Similarly, the presence of eosinophils meeting these thresholds in an excisional specimen should prompt a thorough evaluation for invasiveness, when evidence of invasion is absent or is suspected by conventional criteria in the initial sections. Journal of Pathology of Nepal (2013) Vol. 3, No.1, Issue 5, 374-378 DOI: http://dx.doi.org/10.3126/jpn.v3i5.7861

Implementation of a Clinical Pathway to Avoid Lumbar Puncture in Febrile Young Infants Aged 29-56 Days Meeting a Set of Low Risk Criteria

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 282A-282A
Author(s):  
Payal K. Gala ◽  
Ashlee L Murray ◽  
Aileen P. Schast ◽  
Christian Minich ◽  
Ashley L. Woodford ◽  
...  
Keyword(s):  
Lumbar Puncture ◽  
Clinical Pathway ◽  
Low Risk ◽  
Risk Criteria ◽  
Young Infants

STUDIES ON SOME BACTERIAL DISEASES IN OREOCHROMIS NILOTICUS WITH SPECIAL REFERENCES TO TREATMENT

2018 ◽  
pp. 39-47
Author(s):  
Viola Zaki ◽  
Ahmed EL-gamal ◽  
Yasmin Reyad
Keyword(s):  
Oreochromis Niloticus ◽  
Bacterial Infections ◽  
Antimicrobial Agents ◽  
Histopathological Examination ◽  
Klebsiella Oxytoca ◽  
Bacterial Isolates ◽  
Bacterial Strains ◽  
Tissue Samples ◽  
Hydropic Degeneration ◽  
Total Prevalence

he present research carried out to study the common bacterial infections in Oreochromis niloticus (Nile tilapia) in Manzala area at Dakahlia governorate and possible antimicrobial agents used for treatment. A total number of 400 fish were randomly collected from Manzala private farms at Dakahlia governorate and subjected to the clinical, bacteriological and histopathological examination. The highest prevalence of bacterial isolates during the whole period of examination of naturally infected O.niloticus was recorded for A.hydrophila (22.66%), followed by V.alginolyticus (19.01%), V.parahemolyticus (13.80%), Streptococcus spp. (12.24%), A.caviae (11.72%), V.cholera (10.16%), A.salmonicida (7.55%), while the lowest prevalence was recorded for Klebsiella oxytoca (2.86%). The seasonal highest total prevalence of bacterial isolates from examined naturally infected O. niloticus was recorded in spring (30.21%), followed by autumn (28.39%), then summer (22.40%) and the lowest prevalence was recorded in winter (19.01%). Histopathological findings of the tissue samples which collected from different organs of naturally infected O.niloticus revealed that spleen show marked hemosiderosis and sever hemorrhage, gills showsever congestion of lamellar capillaries with marked aneurysm, necrosis and hemorrhage of lamellar epithelium and liver show sever hydropic degeneration and necrosis of hepatocytes, Ciprofloxacin was the most effective antibiotic against all isolated bacterial strains

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