Mintegi S, et al. - In this prospective registry-based cohort study, the researchers determined the prevalence of invasive bacterial infections (IBI) in infants less than 90 days old with fever without a source related to the presence or absence of fever on arrival to the Emergency Department (ED). Regardless of the presence of fever on the arrival at the ED, the prevalence of IBI in infants ≤90 days with a history of fever was similar. Findings suggested that the approach to infants with a history of fever who were afebrile in the ED should not differ from that recommended for infants who were febrile in the ED.

Methods

• This research was performed at paediatric ED of a tertiary teaching hospital.
• From 2003 to 2016, infants less than 90 days old with a history of fever evaluated in the ED were included.
• The prevalence of IBI in subjects with a history of fever who were febrile and afebrile on arrival to the ED was the main outcome.

Results

• Two thousand, four hundred seventy infants were included: 678 afebrile and 1792 febrile when evaluated in the ED.
• It was noted that 59 (2.4%) were diagnosed with an IBI (bacteraemia 46, meningitis 7 and sepsis 6): 16 in the group of afebrile infants with a history of fever (2.4%, 95% CI 1.4 to 3.8 vs 43 in the febrile group, 2.4%, 95% CI 1.8 to 3.2).
• It was observed that out of the 16 afebrile infants with a history of fever diagnosed with an IBI, 14 were well appearing.
• According to the findings obtained, the rate of non-IBI (pathogenic bacteria in urine or stools) was similar in both groups (15.5% and 16.7%).