The American Academy of Pediatrics (AAP) clinical practice guideline (CPG) for management of well-appearing, febrile infants can
help detect invasive bacterial infections (IBI) without C-reactive protein (CRP) and procalcitonin (PCT), according to a study published in Pediatrics. Dustin Ballard, MD, MBE, and colleagues examined infants aged 8-60 days presenting at EDs with temperatures of 38 degrees Celsius or higher. The researchers identified 57 bacteremia and nine bacterial meningitis cases among 1,433 eligible infants (4.0% and 0.6%, respectively). Three infants (5%) with IBI were misidentified using an absolute neutrophil
count of greater than 5,200/mm3 and temperature of more than 38.5 degrees Celsius as inflammatory markers. For each age group, the sensitivities and specificities for detecting infants with IBIs were 100% and 0% percent, respectively, for 8-21 days; 88.9% and 40.4%, respectively, for 22-28 days; and 93.3% and 32.1%, respectively, for 29-60 days. “Compared with some other protocols not utilizing CRP and PCT, the AAP CPG may recommend more invasive interventions while detecting IBI with similar sensitivity,” Dr. Ballard and colleagues wrote. “Further studies may inform best practices to reduce unnecessary interventions.”