Etiology, Treatment, and Outcome of Children Aged 3 to 36 Months With Fever Without a Source at a Community Hospital in Southern Thailand

Abstract

Background: Fever without a source (FWS) in young children can result from occult bacteremia, urinary tract infection (UTI), meningitis, or certain viral infections. In rural areas of Thailand, where bacterial cultures are not available in some community hospitals, the appropriate examination and management of FWS remain controversial. Methods: We retrospectively searched electronic medical records for medical diagnoses associated with FWS and evaluated the characteristics and clinical courses of children aged 3 to 36 months with FWS who were admitted to a community hospital in southern Thailand between January 2015 and December 2016. Results: Sixty-seven children aged 3 to 36 months with an initial diagnosis of FWS were enrolled. The median age was 11 months (interquartile range [IQR] 8-21 months). Complete blood counts, blood cultures, urine analysis results and urinary cultures were obtained from 67 (100.0%), 31 (46.3%), 47 (70.1%), and 7 (10.5%) patients, respectively. The most common empirical antibiotic administered to these patients was ceftriaxone (71.6%); however, 4 patients recovered without antibiotic administration. The median duration of intravenous antibiotic administration was 4 days (IQR 2-4 days). Intravenous antibiotics were replaced by oral antibiotics in 38 patients (62.3%). The median time to fever subsidence was 30 hours (IQR 12-60 hours). Regarding final diagnoses, 5 patients (7.5%) were diagnosed with culture-confirmed UTI, and 2 (3.0%) had bacteremia (due to contamination). The majority of the children (60, 89.6%) retained the diagnosis of FWS. Presentation at the hospital was significantly earlier in children with culture-confirmed UTI (median 1 day) than in those with culture-negative FWS (median 3 days) ( P = .019). Discussion: We evaluated the characteristics and clinical courses of young children with FWS presenting at a community hospital and the treatment approaches utilized by physicians. Although all patients had good prognoses during the study period, we identified several areas for improvement in conducting proper examinations (especially assessments for UTI in children presenting within the first day of fever onset).