Abstract
Abstract
Background
Fever is a cause for concern for both parents and the treating pediatrician and a common reason for antibiotic overuse. However, the proportion of children hospitalized for fever with serious bacterial infection (SBI) is uncertain. We aimed to evaluate the epidemiological, clinical, hematological, and biochemical risks for SBI among the children admitted with fever.
Method
This prospective study was conducted in a rural teaching hospital in India on consecutive children, aged 3 months–12 years, presenting with fever 100 °F (37.7 °C) or higher. The presence of SBI was confirmed with one of the following criteria: (a) a positive blood culture; (b) roentgenographically confirmed pneumonia with high titres of C-reactive protein; (c) a culture-confirmed urinary tract infection; (d) enteric fever diagnosed clinically in addition to either a positive blood culture or high Widal titers; and (e) meningitis diagnosed clinically in addition to either a positive blood culture or cerebrospinal fluid culture. A predefined questionnaire was filled.
Results
A total of 302 children were included in the study, out of which 47% (95% CI 41.4–52.7%) presented with SBI. The factors associated with confirmed SBI in bivariate analysis were history of previous hospitalization, history of chronic illness, history of medication in the previous 1 week, a partially immunized child, history of common cold, moderate-grade fever, toxic look, significant lymphadenopathy, absence of BCG scar, delayed development, irritability, breathlessness, respiratory distress, poor feeding, significant weight loss, suspected urinary tract infection, hyponatremia, hypokalemia, and abnormal leucocyte count. The final generalized logistic regression model revealed partially immunized child (RR 4.26), breathlessness (RR 1.80), weight loss (RR 2.28), and suspected urinary tract infection (RR 1.95) as risk factors for the increased risk of SBI.
Conclusion
The study identified multiple risk factors for SBI. Pediatricians can be made aware of these risk factors. Further studies are warranted to identify age-specific risk factors for SBI because most clinicians depend on clinical signs and symptoms to identify SBI.
Publisher
Springer Science and Business Media LLC
Reference45 articles.
1. NICE: Feverish Illness in Children: Assessment and Initial Management in Children Younger than 5 Years. National Institute for Health and Care Excellence Clinical guideline No. 160. 2013 NICE, London. [Available from: https://www.nice.org.uk/CG047].
2. Child Global Burden of Diseases, Adolescent Health, Reiner RC Jr, Olsen HE, Ikeda CT, Echko MM, Ballestreros KE, Manguerra H, Martopullo I, Millear A, et al. Diseases, Injuries, and Risk Factors in Child and Adolescent Health, 1990 to 2017: Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2017 Study. JAMA Pediatr. 2019;173(6):e190337.
3. Kliegman R, Geme III J St., Blum N, Shah S, Wilson K, Beherman R (ed.). Nelson Textbook of Pediatrics, 21st Edition. Philadelphia: Elsevier Inc; 2020.
4. Kanchanachitra C, Lindelow M, Johnston T, Hanvoravongchai P, Lorenzo FM, Huong NL. Wilopo SA, dela Rosa JF: human resources for health in Southeast Asia: shortages, distributional challenges, and international trade in health services. Lancet. 2011;377(9767):769–81.
5. Pathak A: Lessons from diagnosis-prescribing and antibiotic resistance surveillance in Ujjain, India : the lull before the storm. Sweden Karoloska Institutet, Stockholm, Sweden; 2012. [Available from: https://openarchive.ki.se/xmlui/handle/10616/40948].