Factors Associated with Adverse Outcomes among Febrile Young Infants with Invasive Bacterial Infections

Febrile Young Infant Research Collaborative

Research output: Contribution to journalArticle

Abstract

Objective: To determine factors associated with adverse outcomes among febrile young infants with invasive bacterial infections (IBIs) (ie, bacteremia and/or bacterial meningitis). Study design: Multicenter, retrospective cohort study (July 2011-June 2016) of febrile infants ≤60 days of age with pathogenic bacterial growth in blood and/or cerebrospinal fluid. Subjects were identified by query of local microbiology laboratory and/or electronic medical record systems, and clinical data were extracted by medical record review. Mixed-effect logistic regression was employed to determine clinical factors associated with 30-day adverse outcomes, which were defined as death, neurologic sequelae, mechanical ventilation, or vasoactive medication receipt. Results: Three hundred fifty infants met inclusion criteria; 279 (79.7%) with bacteremia without meningitis and 71 (20.3%) with bacterial meningitis. Forty-two (12.0%) infants had a 30-day adverse outcome: 29 of 71 (40.8%) with bacterial meningitis vs 13 of 279 (4.7%) with bacteremia without meningitis (36.2% difference, 95% CI 25.1%-48.0%; P <.001). On adjusted analysis, bacterial meningitis (aOR 16.3, 95% CI 6.5-41.0; P <.001), prematurity (aOR 7.1, 95% CI 2.6-19.7; P <.001), and ill appearance (aOR 3.8, 95% CI 1.6-9.1; P =.002) were associated with adverse outcomes. Among infants who were born at term, not ill appearing, and had bacteremia without meningitis, only 2 of 184 (1.1%) had adverse outcomes, and there were no deaths. Conclusions: Among febrile infants ≤60 days old with IBI, prematurity, ill appearance, and bacterial meningitis (vs bacteremia without meningitis) were associated with adverse outcomes. These factors can inform clinical decision-making for febrile young infants with IBI.

Original languageEnglish (US)
Pages (from-to)177-182.e1
JournalJournal of Pediatrics
Volume204
DOIs
StatePublished - Jan 2019

Fingerprint

Bacterial Infections
Bacterial Meningitides
Fever
Bacteremia
Meningitis
Electronic Health Records
Microbiology
Artificial Respiration
Information Systems
Nervous System
Multicenter Studies
Medical Records
Cerebrospinal Fluid
Cohort Studies
Retrospective Studies
Logistic Models
Growth

Keywords

  • bacteremia
  • bacterial meningitis
  • prematurity

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Factors Associated with Adverse Outcomes among Febrile Young Infants with Invasive Bacterial Infections. / Febrile Young Infant Research Collaborative.

In: Journal of Pediatrics, Vol. 204, 01.2019, p. 177-182.e1.

Research output: Contribution to journalArticle

Febrile Young Infant Research Collaborative. / Factors Associated with Adverse Outcomes among Febrile Young Infants with Invasive Bacterial Infections. In: Journal of Pediatrics. 2019 ; Vol. 204. pp. 177-182.e1.
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abstract = "Objective: To determine factors associated with adverse outcomes among febrile young infants with invasive bacterial infections (IBIs) (ie, bacteremia and/or bacterial meningitis). Study design: Multicenter, retrospective cohort study (July 2011-June 2016) of febrile infants ≤60 days of age with pathogenic bacterial growth in blood and/or cerebrospinal fluid. Subjects were identified by query of local microbiology laboratory and/or electronic medical record systems, and clinical data were extracted by medical record review. Mixed-effect logistic regression was employed to determine clinical factors associated with 30-day adverse outcomes, which were defined as death, neurologic sequelae, mechanical ventilation, or vasoactive medication receipt. Results: Three hundred fifty infants met inclusion criteria; 279 (79.7{\%}) with bacteremia without meningitis and 71 (20.3{\%}) with bacterial meningitis. Forty-two (12.0{\%}) infants had a 30-day adverse outcome: 29 of 71 (40.8{\%}) with bacterial meningitis vs 13 of 279 (4.7{\%}) with bacteremia without meningitis (36.2{\%} difference, 95{\%} CI 25.1{\%}-48.0{\%}; P <.001). On adjusted analysis, bacterial meningitis (aOR 16.3, 95{\%} CI 6.5-41.0; P <.001), prematurity (aOR 7.1, 95{\%} CI 2.6-19.7; P <.001), and ill appearance (aOR 3.8, 95{\%} CI 1.6-9.1; P =.002) were associated with adverse outcomes. Among infants who were born at term, not ill appearing, and had bacteremia without meningitis, only 2 of 184 (1.1{\%}) had adverse outcomes, and there were no deaths. Conclusions: Among febrile infants ≤60 days old with IBI, prematurity, ill appearance, and bacterial meningitis (vs bacteremia without meningitis) were associated with adverse outcomes. These factors can inform clinical decision-making for febrile young infants with IBI.",
keywords = "bacteremia, bacterial meningitis, prematurity",
author = "{Febrile Young Infant Research Collaborative} and Pruitt, {Christopher M.} and Neuman, {Mark I.} and Shah, {Samir S.} and Veronika Shabanova and Christopher Woll and Wang, {Marie E.} and Alpern, {Elizabeth R.} and Williams, {Derek J.} and Laura Sartori and Sanyukta Desai and Leazer, {Rianna C.} and Marble, {Richard D.} and McCulloh, {Russell J.} and DePorre, {Adrienne G.} and Rooholamini, {Sahar N.} and Lumb, {Catherine E.} and Fran Balamuth and Sarah Shin and Aronson, {Paul L.} and Nigrovic, {Lise E.} and Browning, {Whitney L.} and Mitchell, {Christine E.} and Peaper, {David R.} and Feldman, {Elana A.}",
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AU - Febrile Young Infant Research Collaborative

AU - Pruitt, Christopher M.

AU - Neuman, Mark I.

AU - Shah, Samir S.

AU - Shabanova, Veronika

AU - Woll, Christopher

AU - Wang, Marie E.

AU - Alpern, Elizabeth R.

AU - Williams, Derek J.

AU - Sartori, Laura

AU - Desai, Sanyukta

AU - Leazer, Rianna C.

AU - Marble, Richard D.

AU - McCulloh, Russell J.

AU - DePorre, Adrienne G.

AU - Rooholamini, Sahar N.

AU - Lumb, Catherine E.

AU - Balamuth, Fran

AU - Shin, Sarah

AU - Aronson, Paul L.

AU - Nigrovic, Lise E.

AU - Browning, Whitney L.

AU - Mitchell, Christine E.

AU - Peaper, David R.

AU - Feldman, Elana A.

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N2 - Objective: To determine factors associated with adverse outcomes among febrile young infants with invasive bacterial infections (IBIs) (ie, bacteremia and/or bacterial meningitis). Study design: Multicenter, retrospective cohort study (July 2011-June 2016) of febrile infants ≤60 days of age with pathogenic bacterial growth in blood and/or cerebrospinal fluid. Subjects were identified by query of local microbiology laboratory and/or electronic medical record systems, and clinical data were extracted by medical record review. Mixed-effect logistic regression was employed to determine clinical factors associated with 30-day adverse outcomes, which were defined as death, neurologic sequelae, mechanical ventilation, or vasoactive medication receipt. Results: Three hundred fifty infants met inclusion criteria; 279 (79.7%) with bacteremia without meningitis and 71 (20.3%) with bacterial meningitis. Forty-two (12.0%) infants had a 30-day adverse outcome: 29 of 71 (40.8%) with bacterial meningitis vs 13 of 279 (4.7%) with bacteremia without meningitis (36.2% difference, 95% CI 25.1%-48.0%; P <.001). On adjusted analysis, bacterial meningitis (aOR 16.3, 95% CI 6.5-41.0; P <.001), prematurity (aOR 7.1, 95% CI 2.6-19.7; P <.001), and ill appearance (aOR 3.8, 95% CI 1.6-9.1; P =.002) were associated with adverse outcomes. Among infants who were born at term, not ill appearing, and had bacteremia without meningitis, only 2 of 184 (1.1%) had adverse outcomes, and there were no deaths. Conclusions: Among febrile infants ≤60 days old with IBI, prematurity, ill appearance, and bacterial meningitis (vs bacteremia without meningitis) were associated with adverse outcomes. These factors can inform clinical decision-making for febrile young infants with IBI.

AB - Objective: To determine factors associated with adverse outcomes among febrile young infants with invasive bacterial infections (IBIs) (ie, bacteremia and/or bacterial meningitis). Study design: Multicenter, retrospective cohort study (July 2011-June 2016) of febrile infants ≤60 days of age with pathogenic bacterial growth in blood and/or cerebrospinal fluid. Subjects were identified by query of local microbiology laboratory and/or electronic medical record systems, and clinical data were extracted by medical record review. Mixed-effect logistic regression was employed to determine clinical factors associated with 30-day adverse outcomes, which were defined as death, neurologic sequelae, mechanical ventilation, or vasoactive medication receipt. Results: Three hundred fifty infants met inclusion criteria; 279 (79.7%) with bacteremia without meningitis and 71 (20.3%) with bacterial meningitis. Forty-two (12.0%) infants had a 30-day adverse outcome: 29 of 71 (40.8%) with bacterial meningitis vs 13 of 279 (4.7%) with bacteremia without meningitis (36.2% difference, 95% CI 25.1%-48.0%; P <.001). On adjusted analysis, bacterial meningitis (aOR 16.3, 95% CI 6.5-41.0; P <.001), prematurity (aOR 7.1, 95% CI 2.6-19.7; P <.001), and ill appearance (aOR 3.8, 95% CI 1.6-9.1; P =.002) were associated with adverse outcomes. Among infants who were born at term, not ill appearing, and had bacteremia without meningitis, only 2 of 184 (1.1%) had adverse outcomes, and there were no deaths. Conclusions: Among febrile infants ≤60 days old with IBI, prematurity, ill appearance, and bacterial meningitis (vs bacteremia without meningitis) were associated with adverse outcomes. These factors can inform clinical decision-making for febrile young infants with IBI.

KW - bacteremia

KW - bacterial meningitis

KW - prematurity

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