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Invasive bacterial infections in young afebrile infants with a history of fever

Abstract

Objective To determine the prevalence of invasive bacterial infections (IBI, pathogenic bacteria in blood or cerebrospinal fluid) in infants less than 90 days old with fever without a source related to the presence or absence of fever on arrival to the emergency department (ED).

Design Prospective registry-based cohort study.

Setting Paediatric ED of a tertiary teaching hospital.

Patients We included infants less than 90 days old with a history of fever evaluated in the ED from 2003 to 2016.

Main outcomes and measures The prevalence of IBI in patients with a history of fever who were febrile and afebrile on arrival to the ED.

Results We included 2470 infants: 678 afebrile and 1792 febrile when evaluated in the ED. Fifty-nine (2.4%) were diagnosed with an IBI (bacteraemia 46, meningitis 7 and sepsis 6): 16 in the group of afebrile infants with a history of fever (2.4%, 95% CI 1.4 to 3.8 vs 43 in the febrile group, 2.4%, 95% CI 1.8 to 3.2). Of the 16 afebrile infants with a history of fever diagnosed with an IBI, 14 were well appearing. The rate of non-IBI (pathogenic bacteria in urine or stools) was similar in both groups (15.5% and 16.7%).

Conclusions The prevalence of IBI in infants ≤90 days with a history of fever is similar regardless of the presence of fever on the arrival at the ED. The approach to infants with a history of fever who are afebrile in the ED should not differ from that recommended for infants who are febrile in the ED.

  • fever
  • infant
  • invasive bacterial infection
  • serious bacterial infection
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