Title

Epidemiology and Etiology of Invasive Bacterial Infection in Infants ≤60 Days Old Treated in Emergency Departments

Creator(s)

Christopher Woll, Yale School of Medicine
Mark I. Neuman, Children's Hospital Boston
Christopher M. Pruitt, The University of Alabama at Birmingham
Marie E. Wang, Stanford University School of Medicine
Eugene D. Shapiro, Yale University
Samir S. Shah, Cincinnati Children's Hospital Medical Center
Russell J. McCulloh, Children's Mercy Hospital
Lise E. Nigrovic, Children's Hospital Boston
Sanyukta Desai, University of Cincinnati College of Medicine
Adrienne G. DePorre, Children's Mercy HospitalFollow
Rianna C. Leazer, Children's Hospital of The King's Daughters Health System
Richard D. Marble, Northwestern University Feinberg School of Medicine
Fran Balamuth, University of Pennsylvania Perelman School of Medicine
Elana A. Feldman, University of Washington School of Medicine
Laura F. Sartori, Vanderbilt University School of Medicine
Whitney L. Browning, Monroe Carell Jr. Children's Hospital at Vanderbilt
Paul L. Aronson, Yale School of Medicine
Elizabeth R. Alpern, Northwestern University Feinberg School of Medicine
Katie L. Hayes, The Children's Hospital of Philadelphia
Brian R. Lee, Children's Mercy HospitalFollow
Catherine E. Lumb, University of Alabama at Birmingham School of Medicine
Christine E. Mitchell, The Children's Hospital of Philadelphia
David R. Peaper, Yale School of Medicine
Sahar N. Rooholamini, University of Washington School of Medicine
Sarah J. Shin, The Children's Hospital of Philadelphia
Derek J. Williams, Monroe Carell Jr. Children's Hospital at Vanderbilt

Document Type

Article

Publication Date

9-1-2018

Identifier

DOI: 10.1016/j.jpeds.2018.04.033; PMCID: PMC6109608

Abstract

© 2018 Elsevier Inc.

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.

Journal Title

Journal of Pediatrics

Volume

200

First Page

210

Last Page

217

Keywords

bacteremia; febrile infant; meningitis; pathogen

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