Thursday, February 21, 2019

A new protocol to diagnose life-threatening bacterial infections in infants: Will this change medical practice?

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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