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Febrile young infants with abnormal urine dipstick at low risk of invasive bacterial infection
  1. Roberto Velasco1,
  2. Ainara Lejarzegi2,
  3. Borja Gomez2,
  4. Mercedes de la Torre3,
  5. Isabel Duran4,
  6. Amaia Camara5,
  7. Daniel de la Rosa6,
  8. Sergio Manzano7,
  9. Jose Rodriguez8,
  10. Andres González9,
  11. Anne-Aurelie Lopes10,
  12. Aristides Rivas11,
  13. Isabel Martinez12,
  14. Carlos Miguel Angelats13,
  15. Sandra Moya14,
  16. Sonia Corral15,
  17. Juan Alonso16,
  18. Patricia del Rio17,
  19. Elena Sancho18,
  20. Ignacio Ruiz del Olmo19,
  21. Inmaculada Nieto20,
  22. Beatriz Vega21,
  23. Santiago Mintegi2
  24. on behalf of the Research in European Pediatric Emergency Medicine (REPEM) and the Spanish Pediatric Emergency Research Group (RISeuP-SPERG)
  1. 1Pediatric Emergency Unit, Rio Hortega University Hospital, Valladolid, Spain
  2. 2Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces. University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
  3. 3Pediatric Emergency Department, Hospital Infantil Universitario Nino Jesus, Madrid, Madrid, Spain
  4. 4Pediatric Emergency Department, Hospital Regional Universitario de Malaga, Malaga, Spain
  5. 5Pediatric Emergency Department, Donostia Ospitalea, Donostia, Spain
  6. 6Pediatric Emergency Department, Hospital Universitario Materno Infantil de Canarias, Las Palmas Gran Canaria, Spain
  7. 7Pediatric Emergency Department, Geneva University Hospital, Geneva, Switzerland
  8. 8Pediatrics, Virgen de la Arrixaca University Hospital, Murcia, Spain
  9. 9Pediatrics, Basurto University Hospital, Bilbao, Spain
  10. 10Pediatric Emergency Department, Robert-Debré Mother-Child University Hospital. Sorbonne University, Paris, France
  11. 11Pediatric Emergency Department, Gregorio Marañón University Hospital, Madrid, Spain
  12. 12Pediatric Emergency Department, Virgen del Rocio University Hospital, Sevilla, Spain
  13. 13Pediatrics, Hospital Francesc de Borja, Gandia, Spain
  14. 14Pediatric Emergency Department, Parc Taulí University Hospital, Sabadell, Spain
  15. 15Pediatrics, Granollers General Hospital, Granollers, Spain
  16. 16Pediatrics, Hospital San Agustín, Linares, Spain
  17. 17Pediatrics, Hospital of Mendaro, Mendaro, Spain
  18. 18Pediatrics, Hospital de San Jorge, Huesca, Spain
  19. 19Pediatrics, Hospital of Barbastro, Barbastro, Spain
  20. 20Pediatrics, Hospital San Juan de Dios del Aljarafe, Sevilla, Spain
  21. 21Pediatrics, Hospital Comarcal de Laredo, Laredo, Spain
  1. Correspondence to Dr Roberto Velasco, Pediatric Emergency Unit, Rio Hortega University Hospital, Valladolid, Castilla y León, Spain; robertovelascozuniga{at}gmail.com

Abstract

Objectives To develop and validate a prediction rule to identify well-appearing febrile infants aged ≤90 days with an abnormal urine dipstick at low risk of invasive bacterial infections (IBIs, bacteraemia or bacterial meningitis).

Design Ambispective, multicentre study.

Setting The derivation set in a single paediatric emergency department (ED) between 2003 and 2017. The validation set in 21 European EDs between December 2017 and November 2019.

Patients Two sets of well-appearing febrile infants aged ≤90 days with an abnormal urine dipstick (either leucocyte esterase and/or nitrite positive test).

Main outcome Prevalence of IBI in low-risk infants according to the RISeuP score.

Results We included 662 infants in the derivation set (IBI rate:5.2%). After logistic regression, we developed a score (RISeuP score) including age (≤15 days old), serum procalcitonin (≥0.6 ng/mL) and C reactive protein (≥20 mg/L) as risk factors. The absence of any risk factor had a sensitivity of 96.0% (95% CI 80.5% to 99.3%), a negative predictive value of 99.4% (95% CI 96.4% to 99.9%) and a specificity of 32.9% (95% CI 28.8% to 37.3%) for ruling out an IBI. Applying it in the 449 infants of the validation set (IBI rate 4.9%), sensitivity, negative predictive value and specificity were 100% (95% CI 87.1% to 100%), 100% (95% CI 97.3% to 100%) and 29.7% (95% CI 25.8% to 33.8%), respectively.

Conclusion This prediction rule accurately identified well-appearing febrile infants aged ≤90 days with an abnormal urine dipstick at low risk of IBI. This score can be used to guide initial clinical decision-making in these patients, selecting infants suitable for an outpatient management.

  • microbiology
  • neonatology
  • nephrology

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Footnotes

  • Twitter @quetzal1980, @MintegiSanti

  • Contributors RV conceptualised and designed the study, analysed the data, wrote the initial draft of the manuscript,and approved the final manuscript as submitted. AL collaborated in the data collection, revised multiple versions of the initial manuscript and critically reviewed the final manuscript. BG and MdlT collaborated in the design of the study and in the data collection, revised multiple versions of the initial manuscript and critically reviewed the final manuscript. ID, AC, DdlR, SMa, JR, AG, A-AL, AR, IM, CMA, SMi, SC, JA, PdR, ES, IRdO, IN and BV reviewed, made suggestions and approved the initial version of the protocol, collaborated in the data collection and reviewed, made suggestions and approved the final manuscript as submitted. SMi conceptualised and designed the study, revised multiple versions of the initial manuscript and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Western Valladolid Clinical Research Ethics Committee CEIC Internal Code 91/17. Derivation set: approval was obtained from the hospital ethics committee. Validation set: The clinical research ethics committee of the coordinating hospital and the institutional review boards of each participating institution approved the study (internal code 91/17). Informed consent was requested from parents or caregivers prior to the inclusion of patients in the validation set.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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