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1.
J Pediatr ; 270: 114017, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38508484

ABSTRACT

Our goal was to identify predictors of invasive bacterial infection (ie, bacteremia and bacterial meningitis) in febrile infants aged 2-6 months. In our multicenter retrospective cohort, older age and lower temperature identified infants at low risk for invasive bacterial infection who could safely avoid routine testing.


Subject(s)
Bacteremia , Emergency Service, Hospital , Fever , Meningitis, Bacterial , Humans , Infant , Retrospective Studies , Male , Female , Fever/etiology , Fever/diagnosis , Meningitis, Bacterial/diagnosis , Bacteremia/diagnosis , Bacteremia/microbiology , Risk Factors , Bacterial Infections/diagnosis
2.
J Pediatr ; 267: 113910, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38218368

ABSTRACT

In this multicenter, cross-sectional, secondary analysis of 4042 low-risk febrile infants, nearly 10% had a contaminated culture obtained during their evaluation (4.9% of blood cultures, 5.0% of urine cultures, and 1.8% of cerebrospinal fluid cultures). Our findings have important implications for improving sterile technique and reducing unnecessary cultures.


Subject(s)
Bacterial Infections , Infant , Humans , Cross-Sectional Studies , Retrospective Studies , Bacterial Infections/complications , Fever/complications , Urinalysis
3.
Pediatr Emerg Care ; 38(2): 83-91, 2022 Feb 01.
Article in English | MEDLINE | ID: mdl-35100745

ABSTRACT

ABSTRACT: Multisystem inflammatory syndrome in children (MIS-C) is a syndrome of abnormal immune response after severe acute respiratory syndrome coronavirus 2 infection that can result in organ dysfunction including severe cardiovascular compromise in children. Increased evidence supports a clinical and laboratory profile in MIS-C distinct from Kawasaki disease, with MIS-C typically occurring in older children and with more prominent gastrointestinal and neurologic symptoms, as well as increased inflammation, lymphopenia, and cardiac injury on laboratory testing. However, high-level evidence regarding best practices for treatment and long-term outcomes in MIS-C is limited.


Subject(s)
COVID-19 , Connective Tissue Diseases , COVID-19/complications , Child , Humans , SARS-CoV-2 , Systemic Inflammatory Response Syndrome
4.
Crit Care Med ; 50(3): 513-516, 2022 03 01.
Article in English | MEDLINE | ID: mdl-35191873
5.
J Pediatr ; 200: 210-217.e1, 2018 09.
Article in English | MEDLINE | ID: mdl-29784512

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.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacteria/isolation & purification , Bacterial Infections/epidemiology , Emergency Service, Hospital , Bacterial Infections/drug therapy , Bacterial Infections/microbiology , Cross-Sectional Studies , Female , Humans , Incidence , Infant , Infant, Newborn , Male , Retrospective Studies , United States/epidemiology
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