Open AccessThe Significance of Clinical and Laboratory Findings in Predicting Serious Bacterial Infections in Children With Acute Fever Without a Focus
Author(s) -
Hasan Demır,
Medine Ayşin Taşar
Publication year - 2020
Publication title -
çocuk enfeksiyon dergisi
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.122
H-Index - 9
eISSN - 1308-5271
pISSN - 1307-1068
DOI - 10.5578/ced.202064
Subject(s) - procalcitonin , erythrocyte sedimentation rate , bacteremia , medicine , white blood cell , c reactive protein , urine , absolute neutrophil count , urinary system , gastroenterology , physical examination , occult , complete blood count , sepsis , neutropenia , pathology , antibiotics , inflammation , biology , alternative medicine , toxicity , microbiology and biotechnology
Objective: Fever is among most common causes of admission to hospital in childhood. In 20% of febrile infants and children, no focus can be identified by physical examination and this group is defined as “acute fever without a focus” (AFWF). Bacteremia (5%), and serious bacterial infection (15%) is determined in of children with AFWF. Clinical scales and laboratory tests are used to detect the risk of occult bacteremia and serious bacterial infection in children with AFWF This study aimed to determine relation between biochemical indicators and YALE Observation Scale, besides, rates of clinical scales and biochemical indicators predicting serious bacterial infections, in 3-36 months children with AFWF. Material and Methods: This study was performed prospectively, in 77 cases, between 3-36 months of AFWF. Low risk criteria was evaluated by performing YALE Observation Scale in children. Complete blood count, absolute neutrophil count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin 6, procalcitonin, urine analysis, chest x-ray, cerebrospinal fluid (CSF) examination; blood, urine and CSF cultures were obtained. Results: The mean age of the patients was 11.0 (4-36) months, 64.9% (n= 50) were boys. Most commonly AFWF recovered in patients (35.0%), and urinary tract infection was diagnosed (32.5%). Severe bacterial infection was determined in 44.2%. When patient groups with and without severe bacterial infection were compared, white blood count, ESH, CRP, and procalcitonin were significantly higher in severe bacterial infection (p< 0.05). Erythrocyte sedimentation rate had highest specificity (87.5%) in discriminating between groups with and without severe bacterial infection. Conclusion: In conclusion, AFWF mostly recovered in children at 3-36 months, and urinary tract infection was common cause. White cell count, ESR, CRP and procalcitonin were found valuable in predicting serious bacterial infection. Further studies are needed to predict interleukin-6 value relevant to serious bacterial infection.