Dahmlow-Narváez EM, Iglesias-Leboreiro J, Bernárdez-Zapata I, Silva-Ramírez H, López-Enríquez CC, Rendón-Macías ME

Language: Spanish
References: 13
Page: 226-231
PDF size: 46.24 Kb.

ABSTRACT

Objective: Learn about the recommendations for the diagnosis of febrile infants without infectious focus apparent, as well as to know the frequency of the use of antibiotics in these children.
Patients and methods: Descriptive study of patients aged one to 36 months hospitalized during the period of 2006-2011. The laboratory tests, image studies, antibiotic indication and final diagnoses frequencies according to age groups.
Results: 60 infants with criteria of fever without source in 5 years were included. 31 patients (51.5%) presented serious bacterial infection: three with meningitis (5%), seven with pneumonias (11.6%), twelve with urinary tract infections (20%), eight with enteritis (6.4%) and one with sepsis (1.6%). The rest had viral infections. Two patients presented noninfectious causes (neoplastic and immunologic disease). In 35 infants (58%), the first phase studies for the etiologic diagnosis were not taken. Antibiotics were used in almost the half of the infants.
Conclusions: The main cause in infants with fever without source was a bacterial infection, especially urinary tract infections. The initial diagnostic approach showed a low compliance with the international guideline recommendation. In most cases there was an appropriate use of antibiotics.

REFERENCES

1. Baraff LJ, Bass JW, Fleisher GR, Klein JO, McCracken GH, Powell KR et al. Practice guideline for the management of infants and children 0 to 36 months of age with fever without source. Ann Emerg Med 1993; 22(7):1198-1210. Erratum in: Ann Emerg Med 1993; 22(9): 1940.

2. El-Radhi AS, Barry W. Thermometry in paediatric practice. Arch Dis Child 2006; 91(4): 351-356.

3. Baraff LJ. Management of fever without source in infants and children. Ann Emerg Med 2000; 36(6): 602-614.

4. Baraff LJ. Editorial: Clinical policy for children younger than three years presenting to the emergency department with fever. Ann Emerg Med 2003; 42(4): 546-549.

5. Ishimine P. Fever without source in children 0 to 36 months of age. Pediatr Clin North Am 2006; 53(2): 167-194.

6. Baraff LJ. Management of infants and young children with fever without source. Pediatr Ann 2008; 37(10): 673-679.

7. McCaig LF, Besser RE, Hughes JM. Trends in antimicrobial prescribing rates for children and adolescents. JAMA 2002; 287(23): 3096-3102.

8. Shaikh N, Morone NE, López J, Chianese J, Sangvai S, D’Amico F et al. Does this child have a urinary tract infection? JAMA 2007; 298(24): 2895-2904.

9. American Academy of Pediatrics, Committee on Quality Improvement, Subcommittee on Urinary Tract Infection. Practice parameter: the diagnosis, treatment, and evaluation, of the initial urinary tract, infection in febrile infants and young children. Pediatrics 1999; 103(4 pt 1): 843-852. Published corrections appear in: Pediatrics 1999; 103(5 pt 1): 1052 and Pediatrics 1999; 104(1 pt1): 118.

10. Bachur R, Perry H, Harper MB. Occult pneumonias: empiric chest radiographs in febrile children with leukocytosis. Ann Emerg Med 1999; 33(2): 166-173.

11. McGowan JE Jr, Bratton L, Klein JO, Finland M. Bacteremia in febrile children seen in a “walk in” pediatric clinic. N Engl J Med 1973; 288(25): 1309-1312.

12. Isaacman DJ, Shults J, Gross TK, Davis PH, Harper M. Predictors of bacteremia in febrile children 3 to 36 months of age. Pediatrics 2000; 106(5): 505-511.

13. Nash DR, Harman J, Wald ER, Kelleher KJ. Antibiotic prescribing by primary care physicians for children with upper respiratory tract infections. Arch Pediatr Adolesc Med 2002; 156(11): 1114-1119.