The appropriateness of early discharge of hospitalized children with suspected sepsis.

ABSTRACT

BACKGROUND: Febrile children with suspected sepsis are often hospitalized and empirically treated with parenteral antibiotics pending results of bacterial cultures. The question of just how long such children should be observed and treated following initial negative culture reports has not been adequately addressed. This study was designed to determine the appropriateness of discharging hospitalized culture-negative children with suspected sepsis at the end of 48 hours. METHODS: All children admitted with a diagnosis of "suspected sepsis" over an 8-month period were prospectively evaluated. Based on initial culture data, children were divided into two groups group A with positive bacterial cultures and group B with negative bacterial cultures. Clinical assessment and review of cerebrospinal fluid, blood, and urine culture data were made at 24 hours, 48 hours, and until discharge, and at 2 weeks following discharge of all group B patients. RESULTS: Of the 83 children enrolled in the study, 8 (9.5%) patients had a culture positive for bacterial infection (group A) meningitis in two, bacteremia in six, and urinary tract infection in two. All cultures were positive within 48 hours. Cultures were negative at 48 hours in the remaining 75 (90.4%) children (group B), and remained negative until discharge and at 2-week follow-up. Eight (10.6%) patients had received antibiotics prior to admission. After the workup, 37 of 73 (50.6%) children received antibiotics for less than 48 hours, while 36 (49.4%) children did so for more than 48 hours. Clinical assessment was normal at 48 hours in 71 of the 75 children. Sixty-three (84%) children available for follow-up continued to do well after discharge. No statistical distinction could be made between those children who remained hospitalized after 48 hours and those children who were dismissed at 48 hours. CONCLUSIONS: Although our study data suggest that culture-negative children hospitalized for suspected sepsis who meet the criteria for normal clinical assessment can be safely discharged at 48 hours, a stronger statistical validation of this approach can be made if a larger sample size is studied.