Background: Fever in infants 1-90 days of age is common. Bacterial meningitis (BM) is a rare, potentially fatal infection that may occur in well-appearing febrile infants (FI). Our objectives were to identify infants with BM in a large population of well-appearing FI and evaluate factors associated with the diagnosis of BM in this population.
Methods: The Intermountain Healthcare System (IHS) is comprised of 22 hospitals across Utah and Idaho and includes Primary ChildrenÕs Hospital, the only pediatric hospital in a catchment of 400,000 sq. miles. IHS has a care process model for the well-appearing FI. We queried the IHS EHR from July 1, 2004- September 30, 2016 and captured data on age, laboratory testing, and outcomes. Diagnosis of BM required positive CSF culture.
Results: We identified 21,135 FI episodes; 54 infants (0.26%) had a diagnosis of BM. Gram-negative organisms predominated in FI 1-28 days [15/24 (63%)] and caused 28/54 (52%) cases overall (Figure 1). FI 1-28 days were significantly more likely to have BM than those 29-90 days (0.41% vs. 0.20%; RR 2.11, 95% CI 1.24-3.61). Laboratory screening showed abnormal white blood cell count in 63% of FI 1-28 days with BM and 50% of FI 29-90 days (p = 0.42); bands were abnormal in 33% and 47% respectively (p = 0.41); urinalysis was abnormal in 21% and 11% (p = 0.42). CSF profile was performed and interpretable in 48/54 (89%); CSF pleocytosis was present in 30/48 [(63%; 15/21 (71%) 1-28 days and 15/27 (56%) p=0.34]. 9/54 (17%) FI with BM would not have been considered "high risk" based on laboratory criteria alone. Of FI with BM, only 31/54 (57%) had bacteremia with the same organism [17/24 (71%) in those 1-28 days; and 14/30 (47%) in those 29-90 days; P=0.099].
Conclusion: BM is rare and challenging to predict in well-appearing FI. Abnormal screening laboratory values identified 83% of FI with BM. Awaiting blood culture results before performing lumbar puncture would potentially miss 40%. Age was the only predictor for BM risk in our cohort.
A. J. Blaschke,
BIoFire Diagnostics, LLC:
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C. L. Byington, BIoFire Diagnostics, LLC: I have intellectual property licensed to BioFire through the University of Utah , Licensing agreement or royalty .