Changing epidemiology of serious bacterial infections in febrile infants without localizing signs.
Abstract
OBJECTIVE: Historically, management of infants with fever without localizing signs
(FWLS) has generated much controversy, with attempts to risk stratify based on several
criteria. Advances in medical practice may have altered the epidemiology of serious
bacterial infections (SBIs) in this population. We conducted this study to test the
hypothesis that the rate of SBIs in this patient population has changed over time.
PATIENTS AND METHODS: We performed a retrospective review of all infants meeting FWLS
criteria at our institution from 1997-2006. We examined all clinical and outcome data
and performed statistical analysis of SBI rates and ampicillin resistance rates. RESULTS:
668 infants met criteria for FWLS. The overall rate of SBIs was 10.8%, with a significant
increase from 2002-2006 (52/361, 14.4%) compared to 1997-2001 (20/307, 6.5%) (p =
0.001). This increase was driven by an increase in E. coli urinary tract infections
(UTI), particularly in older infants (31-90 days). CONCLUSIONS: We observed a significant
increase in E. coli UTI among FWLS infants with high rates of ampicillin resistance.
The reasons are likely to be multifactorial, but the results themselves emphasize
the need to examine urine in all febrile infants <90 days and consider local resistance
patterns when choosing empiric antibiotics.
Type
Journal articleSubject
Age DistributionAmpicillin
Anti-Bacterial Agents
Bacterial Infections
Drug Resistance, Bacterial
Female
Humans
Infant
Infant, Newborn
Male
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https://hdl.handle.net/10161/4568Published Version (Please cite this version)
10.1371/journal.pone.0012448Publication Info
Watt, Kevin; Waddle, Erica; & Jhaveri, Ravi (2010). Changing epidemiology of serious bacterial infections in febrile infants without localizing
signs. PLoS One, 5(8). pp. e12448. 10.1371/journal.pone.0012448. Retrieved from https://hdl.handle.net/10161/4568.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Kevin Michael Watt
Associate Professor of Pediatrics
Dr. Watt’s career goal is to advance public health by integrating physiology and pharmacology
into approaches for designing and conducting early-phase trials in critically ill
children. His current efforts focus on the use of physiologically-based pharmacokinetic
modeling and simulation to understand drug disposition in children on extracorporeal
life support. His research is supported by the NICHD-sponsored Pediatric Critical
Care Scientist Development Program and a NICHD-sponsored Car

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