A new protocol, which measures the levels of
bacteria in urine, serum procalcitonin and absolute neutrophil count may help
to rule out life-threatening bacterial infections among infants up to 2 months
of age who have fevers, potentially eliminating the need for spinal taps,
unnecessary antibiotic treatments or expensive hospital stays, according to new
research published online Feb. 18, 2019 in JAMA Pediatrics.
Researchers from the Pediatric Emergency Care
Applied Research Network (PECARN) developed the protocol from a prospective,
observational study of 1821 infants seen at 26 emergency departments across the
US.
The researchers ruled out a serious bacterial
infection if tests showed low levels of bacteria and procalcitonin and a normal
neutrophil count.
They were able to accurately rule out all but three
of the 170 cases of serious bacterial infection ultimately detected, including
all cases of meningitis. The rule sensitivity was 97.7%, specificity was 60.0%
and negative predictive value was 99.6%. However, the authors note that their
findings need to be verified in a larger sample before they can be applied to
medical practice.
Previous studies suggest that 8 to 13 percent of
infants up to 2 months of age who have a fever may have a serious bacterial
infection (SBI). These include urinary tract infections, bacteremia (bacteria
in the blood) and bacterial meningitis (bacterial infection of the membrane
housing the brain and spinal cord). Often, a physician will need to confirm a
diagnosis with a spinal tap (lumbar puncture), in which a small amount of fluid
is extracted from the spinal canal. Although complications of the procedure are
rare, they include inflammation of the spinal canal, bleeding and headache. In
addition, an infant may be given antibiotics when a bacterial infection is
suspected and may be admitted to a hospital for observation.
(Source: NIH; JAMA
Pediatr. Published online February 18, 2019)
Dr KK
Aggarwal
Padma
Shri Awardee
President
Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)
Group
Editor-in-Chief IJCP Publications
President
Heart Care Foundation of India
Past
National President IMA
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