33 results on '"Borja, Gomez"'
Search Results
2. Impacto de la pandemia de COVID-19 en las infecciones bacterianas invasivas en urgencias
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Garazi Martin-Irazabal, Iker Gangoiti, Borja Gomez, Libe Lizarraga, and Santiago Mintegi
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Pediatrics, Perinatology and Child Health - Published
- 2023
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Catalog
3. Blood enterovirus polymerase chain reaction testing in young febrile infants
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Javier Benito, Leire Bonilla, Maitane Aranzamendi, Santiago Mintegi, Carla Pintos, and Borja Gomez
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Adult ,Male ,medicine.medical_specialty ,Fever ,medicine.drug_class ,Urinary system ,Antibiotics ,Urine ,medicine.disease_cause ,Polymerase Chain Reaction ,Young infants ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Cerebrospinal fluid ,law ,030225 pediatrics ,Internal medicine ,Enterovirus Infections ,Prevalence ,medicine ,Humans ,030212 general & internal medicine ,Polymerase chain reaction ,Aged ,Enterovirus ,business.industry ,Infant, Newborn ,Infant ,Bacterial Infections ,Dipstick ,Length of Stay ,Middle Aged ,Anti-Bacterial Agents ,Pediatrics, Perinatology and Child Health ,business - Abstract
ObjectiveTo analyse the impact of blood enterovirus and human parechovirus PCR (ev-PCR) testing in young infants with fever without a source (FWS).DesignObservational study, subanalysis of a prospective registry.SettingPaediatric emergency department.PatientsInfants ≤90 days of age with FWS seen between September 2015 and August 2019 with blood ev-PCR, blood and urine cultures and urine dipstick test performed.Main outcome measuresPrevalence of invasive bacterial infection (IBI: bacterial pathogen in blood or cerebrospinal fluid) in infants with positive or negative ev-PCR test results. Secondarily, we also compared length of stay and antibiotic treatment in hospitalised infants.ResultsOf 703 infants, 174 (24.7%) had a positive blood ev-PCR and none of them were diagnosed with an IBI (vs 2.6% (95% CI 1.3% to 4.0%) of those with a negative result, p=0.02). Prevalence of non-IBI (mainly urinary tract infection) was also lower among infants with a positive blood ev-PCR (2.3% (95% CI 0.1% to 4.5%) vs 17.6% (95% CI 14.3% to 20.8%), pOverall, 258 infants were hospitalised (36.6%) and 193 (74.8%) of them received antibiotics. Length of hospital stay and antibiotic treatment were shorter in those with a positive blood ev-PCR (median: 3 days vs 5 days and 1 day vs 5 days, respectively; p21 days old with normal urine dipstick.ConclusionBlood ev-PCR identifies a group of infants under 90 days of age with FWS at very low risk of IBI. This test may help to guide clinical decision making in young febrile infants. more...
- Published
- 2021
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4. Rate of invasive bacterial infection in recently vaccinated young infants with fever without source
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Ana Barreiro-Parrado, Eider Lopez, Borja Gomez, Ainara Lejarzegi, Amaia Fernandez-Uria, Javier Benito, and Santiago Mintegi
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Pediatrics, Perinatology and Child Health - Abstract
ObjectiveTo compare the rates of invasive bacterial infection (IBI) (bacterial pathogen in blood or cerebrospinal fluid) and urinary tract infection (UTI) in febrile infants between 42 and 90 days of age who had and had not been vaccinated in the previous 48 hours.DesignObservational study; secondary analysis of a prospective registry-based cohort study.SettingPaediatric emergency department.PatientsInfants 42–90 days of age with fever without source seen between 2010 and 2021.Main outcome measuresRates of IBI (bacterial pathogen in blood or cerebrospinal fluid) and UTI (urine culture obtained by an aseptic method yielding growth of ≥10 000 cfu/mL with associated leucocyturia).ResultsWe included 1522 infants, including 185 (12.2%) vaccinated in the previous 48 hours. Overall, 19 (1.25%) were diagnosed with an IBI and 282 (18.5%) with a UTI. No recently immunised infants were diagnosed with an IBI (vs 19, 1.4% of those not recently immunised, p=0.2). The UTI rate was higher in infants not recently immunised (20.1% vs 7.0%, pConclusionsAlthough the rate of UTI in recently immunised infants 42–90 days old with fever without a source is lower than in those not recently immunised, recommending screening for UTI seems appropriate. If the lower rate of IBI among recently immunised well-appearing infants is confirmed, the recommendation to systematically perform blood tests in these infants should be reconsidered. more...
- Published
- 2022
5. Impact of the Step-by-Step on febrile infants
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Javier Benito, Borja Gomez, Amaia Fernandez-Uria, Santiago Mintegi, and Ainara Lejarzegi
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Male ,medicine.medical_specialty ,Health Planning Guidelines ,Fever of Unknown Origin ,Spinal Puncture ,Patient Admission ,Paediatric emergency medicine ,Sepsis ,medicine ,Humans ,Prospective Studies ,Quality of care ,Quality of Health Care ,Pediatric Emergency Medicine ,business.industry ,Infant, Newborn ,Infant ,Bacterial Infections ,Anti-Bacterial Agents ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Health Resources ,Resource use ,Female ,Observational study ,Guideline Adherence ,Safety ,business ,Paediatric emergency - Abstract
ObjectiveTo evaluate the impact of introducing the Step-by-Step approach on care quality in young febrile infants.DesignObservational study including infants ≤90 days old with fever without source seen in a paediatric emergency department 5 years before (n=1222) and after (n=1151) its introduction. Quality of care was evaluated in terms of adherence to recommendations, resource use and safety.ResultsAdherence: percentages of infants undergoing both urine and blood tests and infants ConclusionThe introduction of the Step-by-Step increased the quality of care provided to young febrile infants. more...
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- 2021
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6. Paediatric Escherichia coli bacteraemia presentations and high‐risk factors in the emergency department
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Borja Elgoibar, Lorea Martinez Indart, Iker Gangoiti, Borja Gomez, Susanna Hernández-Bou, Santiago Mintegi, and Juan José García-García
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medicine.medical_specialty ,Urinary system ,Severe disease ,Bacteremia ,Disease cluster ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,030225 pediatrics ,Internal medicine ,Escherichia coli ,medicine ,Humans ,030212 general & internal medicine ,Risk factor ,Child ,Escherichia coli Infections ,business.industry ,Infant ,General Medicine ,High risk factors ,Emergency department ,bacterial infections and mycoses ,Confidence interval ,Anti-Bacterial Agents ,Cross-Sectional Studies ,Underlying disease ,Child, Preschool ,Urinary Tract Infections ,Pediatrics, Perinatology and Child Health ,Emergency Service, Hospital ,business - Abstract
AIM Escherichia coli (E coli) is a known cause of paediatric bacteraemia. The main objective was to characterise the emergency department (ED) presentations of paediatric E coli bacteraemia and secondarily to identify those related to greater severity. METHODS This was a sub-study of a multicentre cross-sectional prospective registry including all with E coli bacteraemia episodes between 2011 and 2016. We used multiple correspondence and cluster analysis to identify different patterns. RESULTS We included 291 patients and 43 met criteria for severe disease (14.3%, 95% confidence interval 11.2-19.3). We identified four types of paediatric E coli bacteraemia presentations. Two (178 patients, 61.2%) were related to well-appearing previously healthy infants with associated urinary tract infection (UTI). Well-appearing children older than 12 months old with underlying disease (n = 60, 20.6%) and non-well-appearing children of different ages (n = 53, 18.2%) corresponded to the other two types; these had associated UTI infrequently and higher severity rate (15% and 50.9%, respectively, higher when compared with the two previous types, P more...
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- 2020
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7. Repeated Emergency Department Visits Among Children with Invasive Bacterial Infections
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Zaloa Gorostizaga, Santiago Mintegi, Javier Benito, Maitane Aranzamendi, Iker Gangoiti, and Borja Gomez
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Male ,Microbiology (medical) ,medicine.medical_specialty ,medicine.drug_class ,Antibiotics ,MEDLINE ,Tertiary Care Centers ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,medicine ,Humans ,030212 general & internal medicine ,Emergency Treatment ,Retrospective Studies ,business.industry ,Infant ,Retrospective cohort study ,Bacterial Infections ,Emergency department ,humanities ,Anti-Bacterial Agents ,Treatment Outcome ,Infectious Diseases ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Female ,Emergency Service, Hospital ,business - Abstract
We carried out a retrospective cohort study of 271 previously healthy children younger than 14 years old diagnosed with invasive bacterial infection in an emergency department. Of them, 72 (26.6%) had previous visits to the emergency department. Not identifying children with an invasive bacterial infection and not administering antibiotics on the first visit was associated with a severe outcome. more...
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- 2021
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8. Invasive Bacterial Infections in Afebrile Infants Diagnosed With Acute Otitis Media
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Andrea T. Cruz, Paul L. Aronson, Colleen K. Gutman, Peter S. Dayan, Carol C Chen, Son H. McLaren, Muhammad Waseem, Suzanne M. Schmidt, Borja Gomez, David C. Sheridan, Samina Ali, Holly R. Hanson, Danielle Cullen, Roberto Velasco, Kelly R. Bergmann, Kajal Khanna, Matthew J. Lipshaw, Amy D. Thompson, Ankita Taneja, Rakesh D. Mistry, Xian Zhao, Abigail M. Schuh, Amanda Bogie, Lise E. Nigrovic, James A. Meltzer, Kenneth Yen, Aijin Wang, Stacey Ulrich, Matthew D. Steimle, Ron L. Kaplan, Jennifer Dunnick, Jonathan R Strutt, Graham C. Thompson, Christopher M. Pruitt, and Fahd A. Ahmad more...
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Male ,medicine.medical_specialty ,Canada ,Cross-sectional study ,Bacteremia ,Meningitis, Bacterial ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Lymphadenitis ,030225 pediatrics ,Internal medicine ,medicine ,Humans ,Blood culture ,Adverse effect ,medicine.diagnostic_test ,business.industry ,Infant, Newborn ,Infant ,Emergency department ,medicine.disease ,Drug Utilization ,United States ,Anti-Bacterial Agents ,Hospitalization ,Otitis Media ,Cross-Sectional Studies ,Spain ,Pediatrics, Perinatology and Child Health ,Female ,Diagnosis code ,business ,Emergency Service, Hospital ,Meningitis - Abstract
OBJECTIVES:To determine the prevalence of invasive bacterial infections (IBIs) and adverse events in afebrile infants with acute otitis media (AOM).METHODS:We conducted a 33-site cross-sectional study of afebrile infants ≤90 days of age with AOM seen in emergency departments from 2007 to 2017. Eligible infants were identified using emergency department diagnosis codes and confirmed by chart review. IBIs (bacteremia and meningitis) were determined by the growth of pathogenic bacteria in blood or cerebrospinal fluid (CSF) culture. Adverse events were defined as substantial complications resulting from or potentially associated with AOM. We used generalized linear mixed-effects models to identify factors associated with IBI diagnostic testing, controlling for site-level clustering effect.RESULTS:Of 5270 infants screened, 1637 met study criteria. None of the 278 (0%; 95% confidence interval [CI]: 0%–1.4%) infants with blood cultures had bacteremia; 0 of 102 (0%; 95% CI: 0%–3.6%) with CSF cultures had bacterial meningitis; 2 of 645 (0.3%; 95% CI: 0.1%–1.1%) infants with 30-day follow-up had adverse events, including lymphadenitis (1) and culture-negative sepsis (1). Diagnostic testing for IBI varied across sites and by age; overall, 278 (17.0%) had blood cultures, and 102 (6.2%) had CSF cultures obtained. Compared with infants 0 to 28 days old, older infants were less likely to have blood cultures (P < .001) or CSF cultures (P < .001) obtained.CONCLUSION:Afebrile infants with clinician-diagnosed AOM have a low prevalence of IBIs and adverse events; therefore, outpatient management without diagnostic testing may be reasonable. more...
- Published
- 2020
9. Etiología y evolución de las infecciones potencialmente graves en lactantes menores de 3 meses febriles
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Mariano Plana Fernández, Roberto Velasco, Maria Luisa Herreros, Nieves De Lucas, Borja Gomez, and Santiago Mintegi
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Cerebrospinal fluid culture ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Serious bacterial infection ,Pediatrics, Perinatology and Child Health ,Bacteraemia ,030212 general & internal medicine ,Urine culture ,Blood culture ,Pediatrics ,RJ1-570 ,Fever without source - Abstract
Resumen: Introducción: Estudios recientes han demostrado cambios en la etiología de las infecciones bacterianas potencialmente graves en lactantes menores de 3 meses de vida con fiebre. El objetivo es describir la microbiología y la evolución de estas infecciones en nuestro entorno. Material y métodos: Subanálisis de un estudio prospectivo y multicéntrico sobre lactantes febriles con menos de 3 meses de edad que consultaron desde el 1 de octubre del 2011 hasta el 30 de septiembre del 2013 en los servicios de urgencias de 19 hospitales infantiles españoles de la Red de investigación de la Sociedad Española de Urgencias de Pediatría/Spanish Pediatric Emergency Research Group (RISeuP/SPERG). Resultados: Se incluyó a 3.401 lactantes menores de 91 días de vida con fiebre sin foco. Hubo 896 cultivos positivos: 766 urocultivos (85,5%), 100 hemocultivos (11,2%), 18 cultivos de líquido cefalorraquídeo (2%), 10 coprocultivos y 2 cultivos umbilicales. Fueron diagnosticados de una infección bacteriana potencialmente grave 784 niños (23%), de los cuales 107 (3,1%) tenían una infección invasora.Escherichia coli (E. coli) fue la bacteria más frecuente de urocultivos (628; 82%), hemocultivos (46; 46%) y cultivos de líquido cefalorraquídeo (7; 38,9%) seguido por Streptococcus agalactiae, que fue aislado en 24 (24%) hemocultivos y 3 (16,7%) cultivos de líquido cefalorraquídeo. Solo hubo 2 infecciones producidas por Listeria monocytogenes. Fallecieron 4 niños y 7 desarrollaron complicaciones graves. Conclusiones: E. coli fue la bacteria más frecuente en urocultivos, hemocultivos y cultivos de líquido cefalorraquídeo de los lactantes con menos de 3 meses de vida y fiebre sin foco, incluso entre los neonatos. Abstract: Background: Recent studies have shown changes in the aetiology of serious bacterial infections in febrile infants ≤ 90 days of age. The aim of this study was to describe the current microbiology and outcomes of these infections in Spain. Material and methods: Sub-analysis of a prospective multicentre study focusing on febrile infants of less than 91 days of life, admitted between October 2011 and September 2013 to Emergency Departments of 19 Spanish hospitals, members of the Spanish Paediatric Emergency Research Group of the Spanish Society of Paediatric Emergencies (RISeuP/SPERG). Results: The analysis included 3,401 febrile infants ≤90 days of age with fever without source. There were 896 positive cultures: 766 urine (85.5%), 100 blood (11.2%), 18 cerebrospinal fluid (2%), 10 stool, and 2 umbilical cultures. Among the 3,401 infants included, 784 (23%) were diagnosed with a serious bacterial infection, and 107 of them (3.1%) with an invasive infection.E. coli was the most common pathogen isolated from urine (628; 82%), blood (46; 46%), and cerebrospinal fluid cultures (7; 38.9%), followed by S. agalactiae that was isolated from 24 (24%) blood cultures and 3 (16.7%) cerebrospinal fluid cultures. There were only 2 L. monocytogenes infections. Four children died, and seven had severe complications. Conclusions: Among infants ≤ 90 days of age with fever without source, E. coli was the most common pathogen isolated from urine, blood, and cerebrospinal fluid cultures. more...
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- 2017
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10. Accuracy of PECARN rule for predicting serious bacterial infection in infants with fever without a source
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Javier Benito, Roberto Velasco, Borja Gomez, and Santiago Mintegi
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Male ,Pediatrics ,medicine.medical_specialty ,Emergency Medical Services ,Population ,Bacteremia ,Clinical prediction rule ,Fever of Unknown Origin ,Sensitivity and Specificity ,Severity of Illness Index ,Young infants ,Teaching hospital ,Hospitals, University ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Secondary analysis ,Medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Registries ,education ,education.field_of_study ,business.industry ,Area under the curve ,Infant, Newborn ,Infant ,Spain ,Pediatrics, Perinatology and Child Health ,Cohort ,Bacterial meningitis ,Female ,business ,Emergency Service, Hospital - Abstract
ObjectiveTo validate the Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN) clinical prediction rule on an independent cohort of infants with fever without a source (FWS).DesignSecondary analysis of a prospective registry.SettingPaediatric emergency department of a tertiary teaching hospital.PatientsInfants ≤60 days old with FWS between 2007 and 2018.Main outcome measuresPrevalence of serious bacterial infection (SBI) and invasive bacterial infection (IBI) in low-risk infants according to the PECARN rule.ResultsAmong the 1247 infants included, 256 were diagnosed with an SBI (20.5%), including 38 IBIs (3.1%). Overall, 576 infants (46.0%; 95% CI 43.4% to 49.0%) would have been classified as low risk of SBI by the PECARN rule. Of them, 26 had an SBI (4.5%), including 5 with an IBI (2 (0.8%) diagnosed with bacterial meningitis). Sensitivity and specificity of the PECARN rule were 89.8% (95% CI 85.5% to 93.0%) and 55.5% (95% CI 52.4% to 58.6%) for SBI, with an area under the curve of 0.726 (95% CI 0.702 to 0.750). Its sensitivity to identify SBIs was 88.6% (95% CI 82.0% to 92.9%) among infants with a ConclusionsThe PECARN clinical rule for identifying SBI performed less well in our population than in the original study. This clinical rule should be applied cautiously in young infants with a short history of fever. more...
- Published
- 2020
11. A positive nitrite test was an independent risk factor for invasive bacterial infections in infants under 90 days of age with fever without source
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Javier Benito, Mercedes de la Torre, Roberto Velasco, Borja Gomez, and Santiago Mintegi
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medicine.medical_specialty ,Multivariate analysis ,Fever ,Urinalysis ,Gastroenterology ,Sensitivity and Specificity ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Risk Factors ,030225 pediatrics ,Internal medicine ,mental disorders ,medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Nitrite ,Risk factor ,Child ,Nitrites ,business.industry ,Infant ,General Medicine ,Dipstick ,Odds ratio ,Bacterial Infections ,medicine.disease ,Confidence interval ,Nitrite test ,chemistry ,Pediatrics, Perinatology and Child Health ,Urinary Tract Infections ,business ,Meningitis - Abstract
Aim This study analysed the association between a positive nitrite dipstick test and an invasive bacterial infection (IBI) in infants younger than 90 days of age with fever without source (FWS). Methods We performed a secondary analysis of data from a prospective multicentre study of infants up to 90 days of age with FWS undergoing care in 19 paediatric EDs between October 2011 and September 2013. Invasive bacterial infection was defined as a positive blood or cerebrospinal fluid culture. Results The dipstick urinalysis was positive for nitrite or leucocyte esterase in 766 (22.5%) of the 3401 infants we studied, and 270 (35.2%) had a dipstick test that was just positive for nitrite. Overall, 107 were diagnosed with an IBI (3.1%). The IBI prevalence was 2.2% among patients with a normal urine dipstick, 4.4% if they had positive leucocyte esterase test results, 8.3% where the nitrite test was positive and 10.6% when both tests were positive. After multivariate analysis, a positive nitrite test remained an independent risk factor for IBI (odds ratio 2.7, 95% confidence interval 1.4-4.9). Conclusion In infants under 90 days of age with FWS, a positive nitrite urine dipstick test was an independent risk factor for IBI. more...
- Published
- 2019
12. Prevalence of Bacterial Infection in Febrile Infant 61-90 Days Old Compared With Younger Infants
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Borja Gomez, Santiago Mintegi, Leire Bonilla, Javier Benito, and Carla Pintos
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Microbiology (medical) ,Pediatrics ,medicine.medical_specialty ,Fever ,MEDLINE ,Bacteremia ,Meningitis, Bacterial ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Sepsis ,Prevalence ,Medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Registries ,Prospective cohort study ,business.industry ,Age Factors ,Infant, Newborn ,Infant ,Bacterial Infections ,medicine.disease ,Infectious Diseases ,Spain ,Pediatrics, Perinatology and Child Health ,Urinary Tract Infections ,business ,Emergency Service, Hospital ,Meningitis ,Cohort study - Abstract
The objective is to compare the prevalence of serious bacterial infection (SBI) and invasive bacterial infection (IBI) in febrile infants60 days of age and in those between 61 and 90 days.Prospective registry-based cohort study including all the infants ≤90 days with fever without a source evaluated in a pediatric emergency department between 2003 and 2017. We compared the prevalence of SBI and IBI in febrile infants60 days of age and those between 61 and 90 days.We included 3,301 infants. Overall, 605 (18.3%) had a SBI (mainly urinary tract infection), of these 81 (2.5%) had an IBI (bacteremia 60, meningitis 12, sepsis 9). The prevalence of SBI in infants60 days old was 18.5% (95% CI: 16.4-20.7) versus 16.6% (95% CI: 14.7-18.7; n.s.) in those between 29 and 60 days and versus 21.5% (95% CI: 18.6-24.7; n.s.) in those28 days of age. The prevalence of IBI among infants60 days old was 1.1% (95% CI: 0.6-2.2) versus 2.3% (95% CI: 1.6-3.3; P0.05) in those between 29 and 60 days and 5.1% (95% CI: 3.7-7.0; P0.05) in those28 days of age. The prevalence of IBI in well appearing60 days was 1.0% (versus 4.5% in those28 days old, P0.01; and 2.0% in those between 29 and 60 days, P = 0.06). All bacterial meningitis, except one, were diagnosed in infants28 days.The prevalence of IBI in febrile infants between 61 and 90 days of age is high enough to support the recommendation for obtaining urine and blood tests in this population. more...
- Published
- 2019
13. Prevalence and Predictors of Bacterial Meningitis in Young Infants With Fever Without a Source
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Estibaliz Catediano, Maria Jesus Martinez, Elena Catalán Martínez, Santiago Mintegi, Begoña Vilar, Amaia Lopez, and Borja Gomez
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Male ,Microbiology (medical) ,Pediatrics ,medicine.medical_specialty ,medicine.disease_cause ,Fever of Unknown Origin ,Spinal Puncture ,Meningitis, Bacterial ,Cerebrospinal fluid ,Streptococcus pneumoniae ,Prevalence ,Humans ,Medicine ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Lumbar puncture ,Neisseria meningitidis ,Infant, Newborn ,Infant ,Retrospective cohort study ,Odds ratio ,medicine.disease ,Infectious Diseases ,Streptococcus agalactiae ,Pediatrics, Perinatology and Child Health ,Female ,business ,Meningitis - Abstract
BACKGROUND Classical criteria differ when performing cerebrospinal fluid (CSF) analysis in infants younger than 90 days with fever without a source (FWS). Our objectives were to analyze the prevalence and microbiology of bacterial meningitis in this group and its prevalence in relation to clinical and laboratory risk factors. METHODS This is a substudy of a prospective registry including all infants of this age with FWS seen between September 2003 and August 2013 in a Pediatric Emergency Department of a Tertiary Teaching Hospital. RESULTS Lumbar puncture was performed in 639 (27.0%) of the 2362 infants with FWS seen, the rate being higher in not well-appearing infants [60.9% vs. 25.7%; odds ratio (OR), 4.49] and in those ≤21 days old (70.1% vs. 20.4%; OR, 9.14). Eleven infants were diagnosed with bacterial meningitis: 9 were ≤21 days old (prevalence 2.8% vs. 0.1%; OR, 30.42) and 5 were not well-appearing infants (5.7% vs. 0.2%; OR, 23.06). Bacteria isolated were Streptococcus agalactiae (3), Escherichia coli (3), Listeria monocytogenes (3), Streptococcus pneumoniae (1) and Neisseria meningitidis (1). None of the 1975 well-appearing infants >21 days old were diagnosed with bacterial meningitis, regardless of whether biomarkers were altered. CONCLUSIONS In infants younger than 90 days with FWS, performing CSF analysis for ruling out bacterial meningitis must be strongly considered in not well-appearing infants and in those ≤21 days old. The recommendation of systematically performing CSF analysis in well-appearing infants 22-90 days of age on the basis of analytical criteria alone must be reevaluated. more...
- Published
- 2015
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14. Clinical prediction models for young febrile infants at the emergency department: an international validation study
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Santiago Mintegi, Ewout W. Steyerberg, Borja Gomez, Vincent Gajdos, Ruud G. Nijman, Karen Milcent, Henriëtte A. Moll, Rianne Oostenbrink, Frank J Smit, Evelien de Vos-Kerkhof, Pediatrics, and Public Health more...
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Calcitonin ,medicine.medical_specialty ,Fever ,Urine ,Urinalysis ,Decision Support Techniques ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Internal medicine ,Epidemiology ,Medicine ,Humans ,030212 general & internal medicine ,Netherlands ,Receiver operating characteristic ,business.industry ,Infant, Newborn ,Infant ,Emergency department ,Dipstick ,Bacterial Infections ,Systematic review ,Spain ,Pediatrics, Perinatology and Child Health ,Cohort ,business ,Emergency Service, Hospital ,Predictive modelling - Abstract
To assess the diagnostic value of existing clinical prediction models (CPM; ie, statistically derived) in febrile young infants at risk for serious bacterial infections.A systematic literature review identified eight CPMs for predicting serious bacterial infections in febrile children. We validated these CPMs on four validation cohorts of febrile children in Spain (age3 months), France (age3 months) and two cohorts in the Netherlands (age 1-3 months and3-12 months). We evaluated the performance of the CPMs by sensitivity/specificity, area under the receiver operating characteristic curve (AUC) and calibration studies.The original cohorts in which the prediction rules were developed (derivation cohorts) ranged from 381 to 15 781 children, with a prevalence of serious bacterial infections varying from 0.8% to 27% and spanned an age range of 0-16 years. All CPMs originally performed moderately to very well (AUC 0.60-0.93). The four validation cohorts included 159-2204 febrile children, with a median age range of 1.8 (1.2-2.4) months for the three cohorts3 months and 8.4 (6.0-9.6) months for the cohort3-12 months of age. The prevalence of serious bacterial infections varied between 15.1% and 17.2% in the three cohorts3 months and was 9.8% for the cohort3-12 months of age. Although discriminative values varied greatly, best performance was observed for four CPMs including clinical signs and symptoms, urine dipstick analyses and laboratory markers with AUC ranging from 0.68 to 0.94 in the three cohorts3 months (ranges sensitivity: 0.48-0.94 and specificity: 0.71-0.97). For the3-12 months' cohort AUC ranges from 0.80 to 0.89 (ranges sensitivity: 0.70-0.82 and specificity: 0.78-0.90). In general, the specificities exceeded sensitivities in our cohorts, in contrast to derivation cohorts with high sensitivities, although this effect was stronger in infants3 months than in infants3-12 months.We identified four CPMs, including clinical signs and symptoms, urine dipstick analysis and laboratory markers, which can aid clinicians in identifying serious bacterial infections. We suggest clinicians should use CPMs as an adjunctive clinical tool when assessing the risk of serious bacterial infections in febrile young infants. more...
- Published
- 2018
15. Invasive bacterial infections in young afebrile infants with a history of fever
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Javier Benito, Santiago Mintegi, Haydee Diaz, Alba Carro, and Borja Gomez
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Male ,medicine.medical_specialty ,Fever ,Bacteremia ,Urine ,medicine.disease_cause ,Teaching hospital ,Body Temperature ,Meningitis, Bacterial ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Internal medicine ,medicine ,Prevalence ,Humans ,In patient ,030212 general & internal medicine ,Prospective Studies ,Registries ,business.industry ,Infant, Newborn ,Infant ,Pathogenic bacteria ,Emergency department ,Bacterial Infections ,medicine.disease ,Spain ,Pediatrics, Perinatology and Child Health ,Female ,business ,Meningitis ,Cohort study - 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. more...
- Published
- 2017
16. Importance of Urine Dipstick in Evaluation of Young Febrile Infants With Positive Urine Culture: A Spanish Pediatric Emergency Research Group Study
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Rebeca Mozun, Helvia Benito, Mercedes de la Torre, Roberto Velasco, Pedro A Merino, Santiago Mintegi, Juan E Trujillo, and Borja Gomez
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Pediatric emergency ,Male ,Pediatrics ,medicine.medical_specialty ,Urinalysis ,Fever ,Urinary system ,MEDLINE ,Urine ,urologic and male genital diseases ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Diagnostic Errors ,Prospective cohort study ,Reagent Strips ,medicine.diagnostic_test ,Group study ,Bacteria ,business.industry ,Infant, Newborn ,Infant ,General Medicine ,Dipstick ,Early Diagnosis ,Spain ,Pediatrics, Perinatology and Child Health ,Urinary Tract Infections ,Emergency Medicine ,Female ,business - Abstract
Guidelines from the American Academy of Pediatrics define urinary tract infection (UTI) as the growth of greater than 50,000 ufc/mL of a single bacterium in a urine culture with a positive urine dipstick or with a urinalysis associated. Our objective was to evaluate the adequacy of this cutoff point for the diagnosis of UTI in young febrile infants.Subanalysis of a prospective multicenter study developed in RISeuP-SPERG Network between October 11 and September 13. To carry out the study, it was performed a comparison of analytical and microbiological characteristics of patients younger than 90 days with fever without focus, taking into account the results of urine dipstick and urine culture.Of a total of 3333 infants younger than 90 days with fever without focus which were included in the study, 538 were classified as UTI in accordance with American Academy of Pediatrics' guidelines. These patients were similar to those who had a positive urine dipstick and a urine culture yielding of 10,000 to 50,000 ufc/mL, and they were different from those who had a normal urine dipstick and a urine culture50,000 ufc/mL, being focused on the isolated bacteria and blood biomarkers values. Forty-five invasive bacterial infections were diagnosed (5.9% of the 756 with a urine culture10,000 ufc/mL). Half of the infants with a normal urine dipstick diagnosed with invasive bacterial infections were younger than 15 days.It might be inadequate to use a threshold of 50,000 cfu/mL to consider a urine culture as positive in young febrile infants given the fact that it would misdiagnose several UTIs. more...
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- 2016
17. Validation of the 'Step-by-Step' Approach in the Management of Young Febrile Infants
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Santiago Mintegi, Laurence Elisabeth Lacroix, Silvia Bressan, Alain Gervaix, Liviana Da Dalt, and Borja Gomez
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Male ,Pediatric emergency ,Pediatrics ,medicine.medical_specialty ,Fever ,Clinical Decision-Making ,Bacteremia ,Risk Assessment ,Sensitivity and Specificity ,Procalcitonin ,Meningitis, Bacterial ,03 medical and health sciences ,0302 clinical medicine ,Arts and Humanities (miscellaneous) ,030225 pediatrics ,Health Status Indicators ,Humans ,Medicine ,Prospective Studies ,030212 general & internal medicine ,Cerebrospinal fluid culture ,Prospective cohort study ,Arthritis, Infectious ,Pediatrics, Perinatology and Child Health ,Medicine (all) ,ddc:618 ,business.industry ,Infant, Newborn ,Infant ,Emergency department ,Perinatology and Child Health ,Predictive value ,Female ,Emergency Service, Hospital ,business ,Intermediate risk ,Risk assessment ,Algorithms - Abstract
BACKGROUND:A sequential approach to young febrile infants on the basis of clinical and laboratory parameters, including procalcitonin, was recently described as an accurate tool in identifying patients at risk for invasive bacterial infection (IBI). Our aim was to prospectively validate the Step-by-Step approach and compare it with the Rochester criteria and the Lab-score.METHODS:Prospective study including infants ≤90 days with fever without source presenting in 11 European pediatric emergency departments between September 2012 and August 2014. The accuracy of the Step-by-Step approach, the Rochester criteria, and the Lab-score in identifying patients at low risk of IBI (isolation of a bacterial pathogen in a blood or cerebrospinal fluid culture) was compared.RESULTS:Eighty-seven of 2185 infants (4.0%) were diagnosed with an IBI. The prevalence of IBI was significantly higher in infants classified as high risk or intermediate risk according to the Step by Step than in low risk patients. Sensitivity and negative predictive value for ruling out an IBI were 92.0% and 99.3% for the Step by Step, 81.6% and 98.3% for the Rochester criteria, and 59.8% and 98.1% for the Lab-score. Seven infants with an IBI were misclassified by the Step by Step, 16 by Rochester criteria, and 35 by the Lab-score.CONCLUSIONS:We validated the Step by Step as a valuable tool for the management of infants with fever without source in the emergency department and confirmed its superior accuracy in identifying patients at low risk of IBI, compared with the Rochester criteria and the Lab-score. more...
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- 2016
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18. Diagnostic Value of Procalcitonin in Well-Appearing Young Febrile Infants
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Paola Berlese, A Ruano, Santiago Mintegi, Daniel Blázquez, M. de la Torre, L. Da Dalt, Silvia Bressan, M Palacios, I. Olaciregui, and Borja Gomez
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serious bacterial infection ,Calcitonin ,Male ,young infant ,Pediatrics ,medicine.medical_specialty ,Fever ,procalcitonin ,invasive bacterial infection ,Calcitonin Gene-Related Peptide ,Fever of Unknown Origin ,Procalcitonin ,Internal medicine ,Humans ,Medicine ,Blood test ,Blood culture ,Protein Precursors ,Risk factor ,Retrospective Studies ,biology ,medicine.diagnostic_test ,business.industry ,C-reactive protein ,Infant, Newborn ,Infant ,Retrospective cohort study ,Bacterial Infections ,Odds ratio ,Confidence interval ,Surgery ,Pediatrics, Perinatology and Child Health ,Emergency Medicine ,biology.protein ,Female ,business ,Value (mathematics) - Abstract
BACKGROUND AND OBJECTIVE: Procalcitonin (PCT) has been introduced in many European protocols for the management of febrile children. Its value among young, well-appearing infants, however, is not completely defined. Our objective was to assess its performance in diagnosing serious bacterial infections and specifically invasive bacterial infections (IBIs) in well-appearing infants aged METHODS: Well-appearing infants aged RESULTS: We included 1112 infants who had PCT measured and a blood culture performed. IBI was diagnosed in 23 cases (2.1%). In the multivariate analysis including clinical and laboratory data, PCT was the only independent risk factor for IBI (odds ratio 21.69; 95% confidence interval [CI] 7.93–59.28 for PCT ≥0.5 ng/mL). Positive likelihood ratios for PCT ≥2 ng/mL and C-reactive protein (CRP) >40 mg/L were 11.14 (95% CI 7.81–15.89) and 3.45 (95% CI 2.20–5.42), respectively. Negative likelihood ratios for PCT CONCLUSIONS: Among well-appearing young infants with FWS, PCT performs better than CRP in identifying patients with IBIs and seems to be the best marker for ruling out IBIs. Among patients with normal urine dipstick results and fever of recent onset, PCT remains the most accurate blood test. more...
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- 2012
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19. Is 15 Days an Appropriate Cut-off Age for Considering Serious Bacterial Infection in the Management of Febrile Infants?
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Javier Benito, Santiago Mintegi, Elena Catalán Martínez, Nerea Barcena, Mari Pinedo, Jorge Barron, Silvia Garcia, and Borja Gomez
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Male ,Microbiology (medical) ,Pediatric emergency ,Pediatrics ,medicine.medical_specialty ,Fever ,Cross-sectional study ,Fever therapy ,Ambulatory care ,Ambulatory Care ,Humans ,Medicine ,business.industry ,Age Factors ,Infant, Newborn ,Disease Management ,Infant ,Bacterial Infections ,Confidence interval ,Hospitalization ,Cross-Sectional Studies ,Infectious Diseases ,Practice Guidelines as Topic ,Pediatrics, Perinatology and Child Health ,Female ,business - Abstract
Febrile infants3 months of age have a greater risk for serious bacterial infection (SBI). The risk is inversely correlated with age. Most protocols recommend admitting to hospital all febrile infants28 days of age. However, as the prevalence of SBI is not homogenous in this age group, some authors have considered decreasing this cut-off age, allowing ambulatory management of selected patients meeting low-risk criteria.To determine whether 15 days is a suitable cut-off age for different approaches to the management of infants with fever.Cross-sectional descriptive study of infants3 months of age with fever without a source seen between September 1, 2003 and August 30, 2010 in the pediatric emergency department of a tertiary teaching hospital. All infants3 months of age with fever without a source (≤ 38 °C) were included. The following data were collected: age, sex, temperature, diagnosis, management in pediatric emergency department, and outcome.Data were collected for 1575 infants; of whom, 311 (19.7%, 95% confidence intervals [CI]: 17.7-21.7) were found to have an SBI. The rate of SBI in the patients who were 15 to 21 days of age was 33.3% (95% CI: 23.7%-42.9%), similar to that among infants who were 7 to 14 days of age (31.9%, 95% CI: 21.1%-42.7%) and higher than among those older than 21 days of age (18.3%, 95% CI: 16.3-20.3%).Febrile infants 15 to 21 days of age had a rate of SBI similar to younger infants and higher than older age infants. It is not appropriate to establish the approach to management of infants with fever based on a cut-off age of 2 weeks. more...
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- 2012
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20. Diagnostic Value of Leukopenia in YOUNG Febrile Infants
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Ana Romero, Santiago Mintegi, Natalia Paniagua, Edurne Lopez, Borja Gomez, and Javier Benito
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Microbiology (medical) ,medicine.medical_specialty ,Fever ,Leukocytosis ,Cross-sectional study ,Leukocyte Count ,Risk Factors ,Streptococcal Infections ,Internal medicine ,Prevalence ,medicine ,Humans ,Risk factor ,Escherichia coli Infections ,Leukopenia ,business.industry ,Infant, Newborn ,Retrospective cohort study ,Bacterial Infections ,Odds ratio ,Normal white blood cell count ,Cross-Sectional Studies ,Infectious Diseases ,Pediatrics, Perinatology and Child Health ,medicine.symptom ,business - Abstract
We performed a 7-year registry-based retrospective study. We included 1365 infants younger than 3 months of age with fever without a source; 81 (5.9%) had
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- 2012
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21. Manejo del lactante febril en urgencias
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Javier Benito, Borja Gomez, and Santiago Mintegi
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business.industry ,Pediatrics, Perinatology and Child Health ,Medicine ,business - Published
- 2010
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22. Blood Culture and Bacteremia Predictors in Infants Less Than Three Months of Age With Fever Without Source
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Santiago Mintegi, Borja Gomez, Andere Egireun, Javier Benito, Diego Garcia, and Eider Astobiza
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Male ,Microbiology (medical) ,Pediatric emergency ,medicine.medical_specialty ,Pediatrics ,Neutrophils ,Cross-sectional study ,Bacteremia ,Fever of Unknown Origin ,Leukocyte Count ,Escherichia coli ,Prevalence ,Humans ,Medicine ,Blood culture ,Retrospective Studies ,Bacteria ,medicine.diagnostic_test ,biology ,business.industry ,C-reactive protein ,Infant, Newborn ,Infant ,Retrospective cohort study ,medicine.disease ,Predictive factor ,Surgery ,Blood ,C-Reactive Protein ,Cross-Sectional Studies ,Streptococcus pneumoniae ,Infectious Diseases ,Pediatrics, Perinatology and Child Health ,Etiology ,biology.protein ,Female ,Emergency Service, Hospital ,business - Abstract
(1) To assess the rate of bacteremia in febrile infants less than 3 months of age admitted to a pediatric emergency department at a tertiary hospital; (2) to describe the bacteria isolated; and (3) to analyze factors related to increased probability of having a positive blood culture.A retrospective, cross-sectional, 5-year descriptive study that includes all infants less than 3 months of age who presented with fever without source (FWS) and had a blood culture performed.A blood culture was performed in 1018 (91.5%) of 1125 infants admitted, and a bacterial pathogen was grown in 23 (2.2%) of these; 8 were associated with a positive urine culture. The most frequently isolated pathogen was Escherichia coli (9), followed by Streptococcus pneumoniae (4). The risk factors detected by multivariate analysis were: (a) being classified as "not well-appearing" (12.5% vs. 1.8%; odds ratio: 8.37) and (b) leukocyturia and/or nitrituria in a urine dipstick test (5.6% vs. 1.6%; odds ratio: 3.73). C-reactive protein value was higher than white blood cell count and absolute neutrophil count in detecting bacteremia; a 70 g/L cut-off had a specificity of 93.8%, but sensitivity of only 69.6%.A positive blood culture rate of 2.2% was found in infants less than 3 months of age with FWS. C-reactive protein, white blood cell count, and absolute neutrophil count were not good bacteremia predictors. We recommend obtaining a blood culture in infants less than 3 months of age with FWS, particularly those patients considered "not well-appearing" and those with leukocyturia and/or nitrituria. more...
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- 2010
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23. Outpatient management of selected young febrile infants without antibiotics
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Lidia Martinez-Virumbrales, Borja Gomez, Santiago Mintegi, Oihane Morientes, and Javier Benito
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Pediatrics ,medicine.medical_specialty ,Fever ,medicine.drug_class ,Antibiotics ,Unnecessary Procedures ,Procalcitonin ,03 medical and health sciences ,0302 clinical medicine ,Ambulatory care ,030225 pediatrics ,medicine ,Ambulatory Care ,Humans ,030212 general & internal medicine ,Prospective Studies ,Registries ,Prospective cohort study ,biology ,medicine.diagnostic_test ,Lumbar puncture ,business.industry ,C-reactive protein ,Infant, Newborn ,Infant ,Bacterial Infections ,Treatment Outcome ,Pediatrics, Perinatology and Child Health ,Absolute neutrophil count ,biology.protein ,business ,Emergency Service, Hospital ,Cohort study - Abstract
ObjectiveTo analyse the outpatient management of selected febrile infants younger than 90 days without systematic lumbar puncture and antibiotics.MethodsA prospective registry-based cohort study including all the infants ≤90 days with fever without a source (FWS) who were evaluated in a paediatric emergency department (ED) over a 7-year period (September 2007–August 2014). We analysed the outcome of those infants with low-risk criteria for serious bacterial infection (SBI) managed as outpatients without antibiotics and without undergoing a lumbar puncture. Low-risk criteria: Well appearing, older than 21 days of age, no leucocyturia, absolute neutrophil count ≤10 000, serum C reactive protein ≤20 mg/L, procalcitonin Results1472 infants with FWS attended the ED. Of these, 676 were classified to be at low risk for SBI without performing a lumbar puncture. After staying ConclusionsOutpatient management without antibiotics and systematic lumbar puncture is appropriate for selected febrile infants younger than 3 months of age with close follow-up. more...
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- 2016
24. Using a urine dipstick to identify a positive urine culture in young febrile infants is as effective as in older patients
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Roberto, Velasco, Helvia, Benito, Rebeca, Mozun, Juan E, Trujillo, Pedro A, Merino, Mercedes, de la Torre, Borja, Gomez, and A, Rodriguez
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Male ,medicine.medical_specialty ,Urinalysis ,Urine ,Older patients ,Internal medicine ,Female patient ,Medicine ,Humans ,Limited evidence ,Prospective Studies ,Nitrites ,Reagent Strips ,medicine.diagnostic_test ,business.industry ,Leucocyte esterase ,Infant, Newborn ,Infant ,General Medicine ,Dipstick ,Surgery ,Pediatrics, Perinatology and Child Health ,Urinary Tract Infections ,Female ,business ,Carboxylic Ester Hydrolases ,Paediatric emergency - Abstract
Aim There is limited evidence about the diagnostic value of urine dipsticks in young febrile infants. The aim of this study was to determine whether urine dipsticks would identify positive urine cultures in febrile infants of less than 90 days of age. Methods This study was a subanalysis of a prospective multicentre study developed in 19 Spanish paediatric emergency departments belonging to the Spanish Paediatric Emergency Research Network. It focused on febrile infants of less than 90 days of age admitted between October 2011 and September 2013. A positive urine culture was defined as the growth of ≥ 50 000 cfu/mL of a single pathogen collected by a sterile method. Results We included 3401 patients, and 176 (12.8%) female patients and 473 (23.3%) males had a positive urine culture. The leucocyte esterase test showed a mean sensitivity of 82.1% and a mean specificity of 92.4%, with a greater mean negative predictive value for females than males (97.8 versus 94.1%) and a greater mean positive predictive value for males than females (79.4% versus 58%). Conclusion The leucocyte esterase test showed the same accuracy in young febrile infants as previously reported findings for older children. It predicted positive urine cultures and also revealed important gender differences. more...
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- 2014
25. RAPID INFLUENZA TEST IN YOUNG FEBRILE INFANTS FOR THE IDENTIFICATION OF LOW-RISK PATIENTS
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Javier Benito, Juan José García-García, Santiago Mintegi, Eider Astobiza, Borja Gomez, Carles Luaces-Cubells, Susanna Hernández-Bou, and Jaume Carrasco-Colom
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Male ,Microbiology (medical) ,medicine.medical_specialty ,Lower risk ,Fever of Unknown Origin ,Young infants ,Internal medicine ,Influenza, Human ,medicine ,Humans ,Blood culture ,Risk factor ,Cerebrospinal fluid culture ,Cerebrospinal Fluid ,medicine.diagnostic_test ,business.industry ,Infant, Newborn ,Infant ,Bacterial Infections ,Emergency department ,medicine.disease ,Blood ,Infectious Diseases ,Molecular Diagnostic Techniques ,Bacteremia ,Pediatrics, Perinatology and Child Health ,Immunology ,Female ,Viral disease ,business - Abstract
We included 381 febrile infants less than 3 months with a blood culture and a rapid influenza test done as part of study of fever. The prevalence of serious bacterial infections was significantly lower in patients in the positive rapid influenza test (RIT) group (3/113; 2.65%; 95% CI: 0-5.6) than in patients in the negative RIT group (47/268; 17.5%; 95% CI: 13-22.0). No patient with a positive RIT had a positive blood culture (vs. 8 in the negative RIT group, 2.98%, 95% CI: 0.9-5.0) The cerebrospinal fluid culture was positive in 5; all of them had a negative RIT. The use of RIT in the Emergency Department on previously well-appearing febrile young infants without a known source during influenza seasons can help to identify infants with a lower risk of developing serious bacterial infections. Routine blood culture may be no longer necessary in infants with a positive RIT. more...
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- 2009
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26. Paediatric community-acquired septic shock: results from the REPEM network study
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J De Dooy, N Boelsma, J Willems, J Naud, E Kerkhof, M Mor, P. Van de Voorde, Dominique Biarent, C R Pinto, Alain Dupont, L. Da Dalt, Javier Benito, Marc Sabbe, Beth L. Emerson, H Waisman, Thierry Detaille, Ian Maconochie, Borja Gomez, N Qureshi, Said Hachimi-Idrissi, N Mullen, R Van Lancker, I Iglowstein, Henriëtte A. Moll, Dincer Yildizdas, David Walker, Çukurova Üniversitesi, Intensive Care, Supporting clinical sciences, Research Group Critical Care and Cerebral Resuscitation, and UCL - (SLuc) Service de soins intensifs more...
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Male ,CHILDREN ,Comorbidity ,Pediatrics ,Child ,Emergency medicine ,Outcome ,Paediatric ,Sepsis ,Shock ,1114 Paediatrics And Reproductive Medicine ,CRITERIA ,Hospital Mortality ,HEMODYNAMIC SUPPORT ,Prognosis ,Shock, Septic ,humanities ,Community-Acquired Infections ,Treatment Outcome ,1117 Public Health And Health Services ,Shock (circulatory) ,Child, Preschool ,Original Article ,Female ,medicine.symptom ,Emergency Service, Hospital ,Life Sciences & Biomedicine ,medicine.medical_specialty ,Adolescent ,Pédiatrie ,INTENSIVE-CARE ,Intensive care ,medicine ,Humans ,Pediatrics, Perinatology, and Child Health ,Intensive care medicine ,Severe sepsis ,Retrospective Studies ,Science & Technology ,business.industry ,Septic shock ,MORTALITY ,Infant ,Retrospective cohort study ,Emergency department ,Length of Stay ,medicine.disease ,EMERGENCY-DEPARTMENT ,SEVERE SEPSIS ,CLINICAL-PRACTICE ,Pediatrics, Perinatology and Child Health ,Human medicine ,business - Abstract
Introduction and purpose of the study With this study we aimed to describe a "true world" picture of severe pae-diatric 'community-acquired' septic shock and establish the feasibility of a future prospective trial on early goal-directed therapy in children. During a 6-month to 1-year retrospective screening period in 16 emergency departments (ED) in 12 different countries, all children with severe sepsis and signs of decreased perfusion were included. Results A 270,461 paediatric ED consultations were screened, and 176 cases were identified. Significant comorbidity was present in 35.8 % of these cases. Intensive care admission was deemed necessary in 65.7 %, mechanical ventilation in 25.9 % and vasoactive medications in 42.9 %. The median amount of fluid given in the first 6 h was 30 ml/kg. The overall mortality in this sample was 4.5 %. Only 1.2 % of the survivors showed a substantial decrease in Paediatric Overall Performance Category (POPC). 'Severe' outcome (death or a decrease ≥2 in POPC) was significantly related (p0.01) to: any desaturation below 90 %, the amount of fluid given in the first 6 h, the need for and length of mechanical ventilation or vasoactive support, the use of dobutamine and a higher lactate or lower base excess but not to any variables of predisposition, infection or host response (as in the PIRO (Predisposition, Infection, Response, Organ dysfunction) concept). Conclusion The outcome in our samplewas very good.Many children received treatment early in their disease course, so avoiding subsequent intensive care. While certain variables predispose children to become septic and shocked, in our sample, only measures of organ dysfunction and concomitant treatment proved to be significantly related with outcome. We argue why future studies should rather be large multinational prospective observational trials and not necessarily randomised controlled trials.©2013 Springer-Verlag Berlin Heidelberg., SCOPUS: ar.j, info:eu-repo/semantics/published more...
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- 2013
27. Clinical and analytical characteristics and short-term evolution of enteroviral meningitis in young infants presenting with fever without source
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Santiago Mintegi, Javier Benito, Mari Cruz Rubio, Borja Gomez, García S, and Diego Garcia
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Pediatrics ,medicine.medical_specialty ,Virus Cultivation ,Irritability ,Fever of Unknown Origin ,Polymerase Chain Reaction ,Spinal Puncture ,Predictive Value of Tests ,Intensive care ,medicine ,Viral meningitis ,Enterovirus Infections ,Humans ,Pleocytosis ,Retrospective Studies ,Hematologic Tests ,medicine.diagnostic_test ,Lumbar puncture ,business.industry ,Infant ,General Medicine ,medicine.disease ,Meningitis, Viral ,Irritable Mood ,Molecular Typing ,Cross-Sectional Studies ,El Niño ,Spain ,Pediatrics, Perinatology and Child Health ,Emergency Medicine ,Absolute neutrophil count ,medicine.symptom ,Emergencies ,business ,Meningitis - Abstract
Objective: The objective of this study was to describe the characteristics of the enteroviral meningitis diagnosed in a pediatric emergency department among infants younger than 3 months with fever without source and its short-term evolution. Methods: This was a retrospective, cross-sectional, 6-year descriptive study including all infants younger than 3 months who presented with fever without source and who were diagnosed with enteroviral meningitis. Results: A lumbar puncture was practiced at their first emergency visit in 398 (29.5%) of 1348 infants, and 65 (4.8%) were diagnosed with enteroviral meningitis, 33 of them (50.7%) between May and July. Among these 65 infants, 61 were classified as well-appearing; parents referred irritability in 16 (25.3%) of them (without statistical significance when compared with infants without meningitis). Forty-one (63.0%) had no altered infectious parameters (white blood cell [WBC] count between 5000 and 15,000/μL, absolute neutrophil count less than 10,000/μL, and C-reactive protein less than 20 g/L), and 39 (60%) had no pleocytosis. All of the 65 infants recovered well, and none of them developed short-term complications. Conclusions: The symptoms in infants younger than 3 months with enteroviral meningitis were similar to those in infants with a self-limited febrile process without intracranial infection. C-reactive protein and WBC count were not good enteroviral meningitis predictors. Cerebrospinal fluid WBC count was normal in many of these infants, so performing a viral test is recommended for febrile infants younger than 3 months in which a lumbar puncture is practiced during warm months. The short-term evolution was benign. more...
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- 2012
28. Use of urine dipstick evaluating young infants with fever without a source and positive urine culture
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Ana Romero, Natalia Paniagua, Javier Benito, Borja Gomez, Edurne Lopez, Santiago Mintegi, and Elena Urra
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Microbiology (medical) ,Biologic marker ,Bacteriuria ,Fever ,business.industry ,Infant, Newborn ,Physiology ,Infant ,Urine ,Dipstick ,Urinalysis ,Young infants ,Infectious Diseases ,Cross-Sectional Studies ,Pediatrics, Perinatology and Child Health ,Escherichia coli ,Medicine ,Humans ,Prospective Studies ,business ,Reagent Strips - Abstract
We analyzed 239 febrile infants3 months of age with a positive urine culture to examine their characteristics. Patients with altered urine dipstick showed more commonly alterations of the biologic markers for bacterial infection, and Escherichia coli was more commonly isolated. Febrile young infants with positive urine culture and negative urine dipstick may not have a urinary tract infection and less aggressive management can be considered. more...
- Published
- 2011
29. 1475 Value of Blood Biomarkers to Identify Young Febrile Infants Diagnosed with Uti at Higher Risk for Bacteremia. Initial Results
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Roberto Velasco, Borja Gomez, Helvia Benito, Santiago Mintegi, M. de la Torre, Juan E Trujillo, and B Serrano
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Pediatrics ,medicine.medical_specialty ,business.industry ,Urinary system ,bacterial infections and mycoses ,medicine.disease ,Lower risk ,Procalcitonin ,Young infants ,medicine.anatomical_structure ,Blood biomarkers ,Bacteremia ,White blood cell ,Pediatrics, Perinatology and Child Health ,medicine ,Absolute neutrophil count ,business - Abstract
Introduction Selected young febrile infants with urinary tract infection (UTI) and lower risk for associated bacteremia can be managed as outpatients. Different biomarkers are useful in the management of febrile young infants but their role in this specific population has not been clarified. Objective To analyze the relationship between blood biomarkers (white blood cell count -WBC-, absolute neutrophil count -ANC-, procalcitonin -PCT- and C-reactive protein -CRP) and the risk of bacteremia in infants under three months with febrile UTI. Patients and Methods Prospective multicentric study developed in 29 Spanish Paediatric Emergency Departments members of the RISEUP-SPERG (Spanish Pediatric Emergency Research Group), including febrile infants less than three months old diagnosed with UTI between October-2011 and March-2012. Results We included 715 infants, being 151 (21.1%) diagnosed with UTI. Forty-five (28.6%) were excluded because not having obtained CRP or PCT. Finally, 106 febrile infants under three months diagnosed with UTI were included (5–4.7 %- with associated bacteremia). Values of WBC and ANC were similar in infants with and without bacteremia (14116 leucocytes/mm 3 , CI 95% 11178–17053 vs 15630, CI 95% 14221–17039; and 8912 neutrophils/mm 3 , CI 95% 4865–12960 vs 8351, CI 95% 7327–9375; respectively). Values of CRP and PCT were significantly lower in patients without bacteremia when compared with those with bacteremia (107.7 mg/L, CI 95% 60.1–155.3; vs 48.8, CI95% 37.9–59.7; and 26.3, CI 95% 6.8–45.9 vs 2.6, CI 95% 1.2–4.0). Conclusion Procalcitonin and C-reactive protein identify better than classical biomarkers young febrile infants with UTI at higher risk for bacteremia. more...
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- 2012
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30. Denouement
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Silvia Bressan, I. Olaciregui, Borja Gomez, Mercedes de la Torre, Santiago Mintegi, Liviana Da Dalt, Paola Berlese, A Ruano, Daniel Blázquez, and M Palacios
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Microbiology (medical) ,medicine.medical_specialty ,Infectious Diseases ,business.industry ,Internal medicine ,parasitic diseases ,Pediatrics, Perinatology and Child Health ,medicine ,Urine ,Dipstick ,business ,Procalcitonin - Abstract
Background and Objectives:The “Lab-score” combining C-reactive protein, procalcitonin and urine dipstick results has recently been derived and validated as an accurate tool for predicting severe bacterial infections (SBIs) in children with fever without source. We aimed to assess the Lab-score usefu more...
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- 2012
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31. PS-144 Performance Of Clinical Prediction Rules In Young Febrile Infants At The Emergency Department
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Rianne Oostenbrink, Yvonne Vergouwe, Borja Gomez, Henriëtte A. Moll, E Kerkhof, and Santiago Mintegi
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Pediatrics ,medicine.medical_specialty ,Receiver operating characteristic ,medicine.diagnostic_test ,business.industry ,Pediatrics, Perinatology and Child Health ,Cohort ,Vital signs ,Medicine ,Diagnostic test ,Emergency department ,business ,Capillary refill - Abstract
Background Clinical prediction rules (CPRs) are developed to aid the identification of serious infections (SI), but their value in young febrile infants remains unclear. Aim To systematically review existing CPRs and subsequently validate these CPRs in two external cohorts of young febrile infants at risk for SI in the Netherlands 1 (N = 925; ≤1 year) and Spain 2 (N = 2148; ≤3 months). Methods We included seven multivariable developed CPRs for febrile children to predict SI, including clinical predictors and/or diagnostic tests results. CPR performance was assessed by sensitivity, specificity, calibration analyses and area under the receiver operating characteristic curve (AUC). Results All CPRs (including 19 different predictors) originally performed moderate-good (AUC0.60–0.93). The original cohorts, with SI prevalence variation of 0.8–27%, varied between 381 and 5279 febrile children. Almost all CPRs were derived in emergency care populations including wide age ranges of 0–16 years. Validation of CPRs missing ≥2/3 of the required variables was not performed, resulting in limited evaluation of two CPRs including eg capillary refill time and vital signs (heart/respiratory rate) in the Spanish cohort. Four out of 7 CPRs showed acceptable ROC-areas (0.76–0.89) in both cohorts. Sensitivities of CPRs predicting high/low risks ranged from 0.60–0.93 and specificities from 0.71–0.97. Three CPRs were non-informative (AUC 0.49–0.53). Calibration slopes were mostly Discussion and Conclusion Four (out of 7) CPRs showed comparable performance in the identification of SI in infants ≤1 year, although with more emphasise on their rule-in value (specificity). However, predictor effects were generally overestimated. more...
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- 2014
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32. 368 Markers for Invasive Bacterial Infection in Well-Appearing Young Febrile Infants. The Value of Procalcitonin
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Santiago Mintegi, A Ruano, M. de la Torre, I. Olaciregui, Borja Gomez, Paola Berlese, Daniel Blázquez, M Palacios, L. Da Dalt, and Silvia Bressan
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medicine.medical_specialty ,Multivariate analysis ,medicine.diagnostic_test ,business.industry ,Normal urine ,Retrospective cohort study ,Dipstick ,Procalcitonin ,Young infants ,Internal medicine ,parasitic diseases ,Pediatrics, Perinatology and Child Health ,medicine ,Blood culture ,Risk factor ,Intensive care medicine ,business ,hormones, hormone substitutes, and hormone antagonists - Abstract
Background In the last decade, the procalcitonin (PCT) has been introduced in many protocols for the management of the febrile child. However, its value among young well-appearing infants is not completely defined. Objective To assess the value of PCT in diagnosing serious bacterial infections and specifically invasive bacterial infections (IBIs) in well-appearing infants under 3 months of age with fever without source (FWS). Design and Methods Retrospective study including well-appearing infants under 3 months of age with FWS attended in seven European Paediatric Emergency Departments. An IBI was defined when a bacterial pathogen was isolated in blood or cerebrospinal fluid culture. Results A total of 1,531 infants under 3 months of age with FWS were attended. There were 1,112 well-appearing infants in whom PCT and a blood culture were performed. Among them, 23 (2.1%) were diagnosed with an IBI. A multivariate analysis showed that, among different epidemicological data and blood tests, PCT was the only independent risk factor for having an IBI (OR 21.69 if PCT 0.5 ng/mL). Comparing with C-Reactive Protein, PCT showed a better performance to rule-in an IBI. Among patients with normal urine dipstick and short-evolution fever (less than 6 hours), areas under the ROC curve were 0.819 and 0.563, respectively for detecting IBIs. Conclusions Among young infants with FWS, PCT showed a better performance than C-Reactive Protein in identifying patients with IBIs and, mainly in those patients with normal urine dipstick and short-evolution fever, PCT seems to be also the best marker to rule out an IBI. more...
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- 2012
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33. 1484 Accuracy of a Sequential Approach to Identify Young Febrile Infants at Low Risk for Invasive Bacterial Infection
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M. de la Torre, A Ruano, Paola Berlese, I. Olaciregui, Borja Gomez, Santiago Mintegi, Javier Benito, M Palacios, L. Da Dalt, and Silvia Bressan
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Pediatric emergency ,Pediatrics ,medicine.medical_specialty ,business.industry ,Blood biomarkers ,Pediatrics, Perinatology and Child Health ,Medicine ,business ,Outpatient management ,Procalcitonin ,Risk criteria ,Young infants - Abstract
Introduction Nowadays it is possible to manage as outpatients selected young febrile infants with low risk criteria for serious bacterial infection. A sequential approach, evaluating, firstly, the appearance of the infant, secondly, the urinanalysis, and, finally, the results of the blood biomarkers, including procalcitonin, may identify better low risk febrile infants suitable for outpatient management. Objective To assess the value of a sequential approach (“step by step”) to febrile young infants in order to identify low risk patients suitable for outpatient management and compare it with other ones previously described (Rochester criteria and Lab-score). Methods A retrospective comparison of three different approaches (“step by step”, Lab-score and Rochester criteria) was made in 1123 febrile infants less than 3 months of age attended in seven European Pediatric Emergency Departments. Results Of the 1123 infants (Invasive Bacterial Infection - IBI-, 48; 4.2%), 488 (43.4%) were classified as low risk criteria for IBI according to the “step by step” approach (vs 693–61.7%- with the Labscore and 458–40.7%- with the Rochester criteria). The prevalence of IBI in the low-risk criteria patients was 0.2% (95% CI 0–0.6%) using the “step by step” approach (vs 0.7%–95% CI 0.1–1.3% with the Labscore and 1.1%–95% CI 0.1–2%- with Rochester). Using the “step by step” approach, 1 patient with IBI was not correctly classified (2.0%, CI95% 0–6.12) vs 5 using the Labscore or Rochester (10.4%, CI95% 1.76–19.04%). Conclusions A sequential approach to young febrile infants including procalcitonin identifies better patients more suitable for outpatient management. more...
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- 2012
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