Epidemiology and Etiology of Invasive Bacterial Infection in Infants ≤60 Days Old Treated in Emergency Departments

Febrile Young Infant Research Collaborative

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objectives: To help guide empiric treatment of infants ≤60 days old with suspected invasive bacterial infection by describing pathogens and their antimicrobial susceptibilities. Study design: Cross-sectional study of infants ≤60 days old with invasive bacterial infection (bacteremia and/or bacterial meningitis) evaluated in the emergency departments of 11 children's hospitals between July 1, 2011 and June 30, 2016. Each site's microbiology laboratory database or electronic medical record system was queried to identify infants from whom a bacterial pathogen was isolated from either blood or cerebrospinal fluid. Medical records of these infants were reviewed to confirm the presence of a pathogen and to obtain demographic, clinical, and laboratory data. Results: Of the 442 infants with invasive bacterial infection, 353 (79.9%) had bacteremia without meningitis, 64 (14.5%) had bacterial meningitis with bacteremia, and 25 (5.7%) had bacterial meningitis without bacteremia. The peak number of cases of invasive bacterial infection occurred in the second week of life; 364 (82.4%) infants were febrile. Group B streptococcus was the most common pathogen identified (36.7%), followed by Escherichia coli (30.8%), Staphylococcus aureus (9.7%), and Enterococcus spp (6.6%). Overall, 96.8% of pathogens were susceptible to ampicillin plus a third-generation cephalosporin, 96.0% to ampicillin plus gentamicin, and 89.2% to third-generation cephalosporins alone. Conclusions: For most infants ≤60 days old evaluated in a pediatric emergency department for suspected invasive bacterial infection, the combination of ampicillin plus either gentamicin or a third-generation cephalosporin is an appropriate empiric antimicrobial treatment regimen. Of the pathogens isolated from infants with invasive bacterial infection, 11% were resistant to third-generation cephalosporins alone.

Original languageEnglish (US)
Pages (from-to)210-217.e1
JournalJournal of Pediatrics
Volume200
DOIs
StatePublished - Sep 2018

Fingerprint

Bacterial Infections
Hospital Emergency Service
Epidemiology
Cephalosporins
Bacteremia
Bacterial Meningitides
Ampicillin
Gentamicins
Streptococcus agalactiae
Electronic Health Records
Enterococcus
Microbiology
Meningitis
Medical Records
Cerebrospinal Fluid
Staphylococcus aureus
Fever
Cross-Sectional Studies
Demography
Databases

Keywords

  • bacteremia
  • febrile infant
  • meningitis
  • pathogen

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Epidemiology and Etiology of Invasive Bacterial Infection in Infants ≤60 Days Old Treated in Emergency Departments. / Febrile Young Infant Research Collaborative.

In: Journal of Pediatrics, Vol. 200, 09.2018, p. 210-217.e1.

Research output: Contribution to journalArticle

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title = "Epidemiology and Etiology of Invasive Bacterial Infection in Infants ≤60 Days Old Treated in Emergency Departments",
abstract = "Objectives: To help guide empiric treatment of infants ≤60 days old with suspected invasive bacterial infection by describing pathogens and their antimicrobial susceptibilities. Study design: Cross-sectional study of infants ≤60 days old with invasive bacterial infection (bacteremia and/or bacterial meningitis) evaluated in the emergency departments of 11 children's hospitals between July 1, 2011 and June 30, 2016. Each site's microbiology laboratory database or electronic medical record system was queried to identify infants from whom a bacterial pathogen was isolated from either blood or cerebrospinal fluid. Medical records of these infants were reviewed to confirm the presence of a pathogen and to obtain demographic, clinical, and laboratory data. Results: Of the 442 infants with invasive bacterial infection, 353 (79.9{\%}) had bacteremia without meningitis, 64 (14.5{\%}) had bacterial meningitis with bacteremia, and 25 (5.7{\%}) had bacterial meningitis without bacteremia. The peak number of cases of invasive bacterial infection occurred in the second week of life; 364 (82.4{\%}) infants were febrile. Group B streptococcus was the most common pathogen identified (36.7{\%}), followed by Escherichia coli (30.8{\%}), Staphylococcus aureus (9.7{\%}), and Enterococcus spp (6.6{\%}). Overall, 96.8{\%} of pathogens were susceptible to ampicillin plus a third-generation cephalosporin, 96.0{\%} to ampicillin plus gentamicin, and 89.2{\%} to third-generation cephalosporins alone. Conclusions: For most infants ≤60 days old evaluated in a pediatric emergency department for suspected invasive bacterial infection, the combination of ampicillin plus either gentamicin or a third-generation cephalosporin is an appropriate empiric antimicrobial treatment regimen. Of the pathogens isolated from infants with invasive bacterial infection, 11{\%} were resistant to third-generation cephalosporins alone.",
keywords = "bacteremia, febrile infant, meningitis, pathogen",
author = "{Febrile Young Infant Research Collaborative} and Christopher Woll and Neuman, {Mark I.} and Pruitt, {Christopher M.} and Wang, {Marie E.} and Shapiro, {Eugene D.} and Shah, {Samir S.} and McCulloh, {Russell J.} and Nigrovic, {Lise E.} and Sanyukta Desai and DePorre, {Adrienne G.} and Leazer, {Rianna C.} and Marble, {Richard D.} and Fran Balamuth and Feldman, {Elana A.} and Sartori, {Laura F.} and Browning, {Whitney L.} and Aronson, {Paul L.} and Alpern, {Elizabeth R.} and Hayes, {Katie L.} and Lee, {Brian R.} and Lumb, {Catherine E.} and Mitchell, {Christine E.} and Peaper, {David R.} and Rooholamini, {Sahar N.} and Shin, {Sarah J.} and Williams, {Derek J.}",
year = "2018",
month = "9",
doi = "10.1016/j.jpeds.2018.04.033",
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pages = "210--217.e1",
journal = "Journal of Pediatrics",
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T1 - Epidemiology and Etiology of Invasive Bacterial Infection in Infants ≤60 Days Old Treated in Emergency Departments

AU - Febrile Young Infant Research Collaborative

AU - Woll, Christopher

AU - Neuman, Mark I.

AU - Pruitt, Christopher M.

AU - Wang, Marie E.

AU - Shapiro, Eugene D.

AU - Shah, Samir S.

AU - McCulloh, Russell J.

AU - Nigrovic, Lise E.

AU - Desai, Sanyukta

AU - DePorre, Adrienne G.

AU - Leazer, Rianna C.

AU - Marble, Richard D.

AU - Balamuth, Fran

AU - Feldman, Elana A.

AU - Sartori, Laura F.

AU - Browning, Whitney L.

AU - Aronson, Paul L.

AU - Alpern, Elizabeth R.

AU - Hayes, Katie L.

AU - Lee, Brian R.

AU - Lumb, Catherine E.

AU - Mitchell, Christine E.

AU - Peaper, David R.

AU - Rooholamini, Sahar N.

AU - Shin, Sarah J.

AU - Williams, Derek J.

PY - 2018/9

Y1 - 2018/9

N2 - Objectives: To help guide empiric treatment of infants ≤60 days old with suspected invasive bacterial infection by describing pathogens and their antimicrobial susceptibilities. Study design: Cross-sectional study of infants ≤60 days old with invasive bacterial infection (bacteremia and/or bacterial meningitis) evaluated in the emergency departments of 11 children's hospitals between July 1, 2011 and June 30, 2016. Each site's microbiology laboratory database or electronic medical record system was queried to identify infants from whom a bacterial pathogen was isolated from either blood or cerebrospinal fluid. Medical records of these infants were reviewed to confirm the presence of a pathogen and to obtain demographic, clinical, and laboratory data. Results: Of the 442 infants with invasive bacterial infection, 353 (79.9%) had bacteremia without meningitis, 64 (14.5%) had bacterial meningitis with bacteremia, and 25 (5.7%) had bacterial meningitis without bacteremia. The peak number of cases of invasive bacterial infection occurred in the second week of life; 364 (82.4%) infants were febrile. Group B streptococcus was the most common pathogen identified (36.7%), followed by Escherichia coli (30.8%), Staphylococcus aureus (9.7%), and Enterococcus spp (6.6%). Overall, 96.8% of pathogens were susceptible to ampicillin plus a third-generation cephalosporin, 96.0% to ampicillin plus gentamicin, and 89.2% to third-generation cephalosporins alone. Conclusions: For most infants ≤60 days old evaluated in a pediatric emergency department for suspected invasive bacterial infection, the combination of ampicillin plus either gentamicin or a third-generation cephalosporin is an appropriate empiric antimicrobial treatment regimen. Of the pathogens isolated from infants with invasive bacterial infection, 11% were resistant to third-generation cephalosporins alone.

AB - Objectives: To help guide empiric treatment of infants ≤60 days old with suspected invasive bacterial infection by describing pathogens and their antimicrobial susceptibilities. Study design: Cross-sectional study of infants ≤60 days old with invasive bacterial infection (bacteremia and/or bacterial meningitis) evaluated in the emergency departments of 11 children's hospitals between July 1, 2011 and June 30, 2016. Each site's microbiology laboratory database or electronic medical record system was queried to identify infants from whom a bacterial pathogen was isolated from either blood or cerebrospinal fluid. Medical records of these infants were reviewed to confirm the presence of a pathogen and to obtain demographic, clinical, and laboratory data. Results: Of the 442 infants with invasive bacterial infection, 353 (79.9%) had bacteremia without meningitis, 64 (14.5%) had bacterial meningitis with bacteremia, and 25 (5.7%) had bacterial meningitis without bacteremia. The peak number of cases of invasive bacterial infection occurred in the second week of life; 364 (82.4%) infants were febrile. Group B streptococcus was the most common pathogen identified (36.7%), followed by Escherichia coli (30.8%), Staphylococcus aureus (9.7%), and Enterococcus spp (6.6%). Overall, 96.8% of pathogens were susceptible to ampicillin plus a third-generation cephalosporin, 96.0% to ampicillin plus gentamicin, and 89.2% to third-generation cephalosporins alone. Conclusions: For most infants ≤60 days old evaluated in a pediatric emergency department for suspected invasive bacterial infection, the combination of ampicillin plus either gentamicin or a third-generation cephalosporin is an appropriate empiric antimicrobial treatment regimen. Of the pathogens isolated from infants with invasive bacterial infection, 11% were resistant to third-generation cephalosporins alone.

KW - bacteremia

KW - febrile infant

KW - meningitis

KW - pathogen

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JO - Journal of Pediatrics

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