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[Total white blood cell count, erythrosedimentation rate and C-reactive protein for the detection of serious bacterial infections in 0- to 90-day-old infants with fever without a source]. / Leucocitos en sangre, eritrosedimentación y proteína C reactiva en pacientes de 0 a 90 días de edad con fiebre sin focalización.
Cuello García, C A; Tamez Gómez, L; Valdez Ceballos, J.
  • Cuello García CA; Departamento de Pediatría, Escuela de Medicina del Tecnológico de Monterrey, Mexico. carlos.cuello@itesm.mx
An Pediatr (Barc) ; 68(2): 103-9, 2008 Feb.
Article en Es | MEDLINE | ID: mdl-18341874
ABSTRACT

INTRODUCTION:

Total white blood cell count (WBC), erythrosedimentation rate (ESR) and C-reactive protein (CRP) are frequently used by primary care physicians attending infants < 90 days old with fever without localizing signs to distinguish those with a serious bacterial infection (SBI). The main objective of this study was to obtain the diagnostic values of these parameters in infants with fever. PATIENTS AND

METHODS:

We analyzed previously healthy infants aged 0 to 90 days old and fever with no source of infection admitted to the emergency room and/or hospitalized. The main outcome measure was the presence or absence of a SBI (urinary tract infection, bacteremia, meningitis, pneumonia, enteritis) and diagnostic values of WBC, ESR and CRP.

RESULTS:

A total of 103 infants met the inclusion criteria. Of these, 22 infants (21.3%) had a SBI, the most common being urinary tract infection. Absolute neutrophil count (ANC) and WBC had an area under the ROC curve (AUC) of 0.6 (95% CI 0.46-0.73) and 0.55 (95% CI 0.44-0.68) respectively. An ANC>or=10,000/microl had a sensitivity and specificity of 9% (95% CI 1-21) and 92.5% (95% CI 86-98) respectively. A WBC>or=15,000/microl had a sensitivity and specificity of 13.6% (95% CI 1-28) and 85% (95% CI 77-93) respectively. CRP showed an AUC of 0.71 (95% CI 0.55-0.86) and a best cut-off point of 2 mg/dL (sensitivity 53% [95% CI 29-76] and specificity of 85% [95% CI 75-94]). ESR>or=20 mm/hour had an AUC, sensitivity and specificity of 0.53 (95% CI 0.37-0.7), 38% (95% CI 16-62) and 75% (95% CI 65-85) respectively.

CONCLUSIONS:

None of these parameters alone, commonly used by physicians, is a reliable diagnostic tool to rule out SBI in infants<90 days old with fever without source of infection.
Asunto(s)
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Banco de datos: MEDLINE Asunto principal: Infecciones Bacterianas / Proteína C-Reactiva / Fiebre de Origen Desconocido Tipo de estudio: Diagnostic_studies / Observational_studies / Prognostic_studies Límite: Female / Humans / Infant / Male / Newborn Idioma: Es Año: 2008 Tipo del documento: Article
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Banco de datos: MEDLINE Asunto principal: Infecciones Bacterianas / Proteína C-Reactiva / Fiebre de Origen Desconocido Tipo de estudio: Diagnostic_studies / Observational_studies / Prognostic_studies Límite: Female / Humans / Infant / Male / Newborn Idioma: Es Año: 2008 Tipo del documento: Article