427. Risk of Serious Bacterial Infections in Previously Healthy, Full-Term, Febrile Infants Ages 1 Week to 3 Months
Session: Poster Abstract Session: Pediatric Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background: Although approximately 7 – 12.6% of febrile infants less than three months will have a serious bacterial infection (SBI), the incidence rate of febrile SBIs in this age is largely unknown. The current rate of febrile infants managed outside of the hospital and / or without bacterial cultures obtained is also not known.

Methods: This study was a retrospective review of the computerized medical database of all febrile, full term, previously healthy infants born between January 1st, 2008 and December 31st, 2011 age 1 week to 3 months old presenting for care in Kaiser Permanente Northern California. SBIs included bacteremia, urinary tract infections (UTIs), bacterial meningitis and bacterial gastroenteritis.

Results: 128,082 full term infants were born during the study period. Excluding infants with underlying medical conditions, 2089 infants had a fever >100.4 o Fahrenheit (38.0 o Celsius) in the clinician’s office, emergency department or first 24 hours of hospitalization. Of these infants, 637 (30.4%) had no bacterial cultures obtained and 302 (14.4%) had a SBI. 395 infants with a fever at home and / or in a medical setting had a total of 441 SBIs with an incidence rate of  3.1 / 1000 full term births. This included 69 bacteremia, 9 bacterial meningitis, 8 bacterial gastroenteritis and 355 UTIs. (Table 1) Infections with more than one source were common and occurred in 44 infants. Bacteremia occurred more frequently with another infection than alone, 44 vs. 25 cases, respectively.

Table 1: Febrile Infants with SBI with 1 Source vs. > 1 Source

Age   of infant (days)

1 Source

> 1 Source

Total  

(>   1 Source)

 

Bacteremia

UTI

Meningitis

Gastroenteritis

UTI + bacteremia

 

Meningitis + bacteremia

Meningitis + UTI +   bacteremia

Gastroenteritis +   bacteremia

 

7-28

10

74

0

2

14

3

0

0

103   (17)

29-60

13

133

1

2

13

1

2

1

166   (17)

61-92

2

111

0

3

8

2

0

0

126   (10)

Total

25

315

1

7

35

6

2

1

395   (44)

Conclusion: Febrile SBIs are uncommon with an incident rate of 3.1 / 1000 full term births. Thirty percent of infants febrile in a medical setting do not have any cultures obtained and have a benign clinical course. Of those with cultures obtained, infections with more than one source are common and are often associated with a UTI.

Tara Greenhow, MD, Pediatric Infectious Diseases, Kaiser Permanente Northern California, San Francisco, CA, Angela Lai, MD, Pediatrics, Kaiser Permanente Northern California, Oakland, CA and Robert Pantell, MD, Pediatrics, University California San Francisco, San Francisco, CA

Disclosures:

T. Greenhow, None

A. Lai, None

R. Pantell, None

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