New Lab-Based, ER Protocol Cuts Invasive Procedures in Febrile Infants

A prediction rule can identify febrile infants at low risk for serious blood infections (SBIs) using urinalysis, absolute neutrophil count (ANC), and procalcitonin levels, according to a study published Feb. 18 in JAMA Pediatrics. The authors say the protocol can both standardize care and potentially cut the need for lumbar punctures, unnecessary antibiotics, and hospitalizations, which have traditionally been included in diagnostic workups due to the serious consequences of a missed SBI (e.g., bacteremia and meningitis) in infants. The researchers from the Pediatric Emergency Care Applied Research Network developed and validated the prediction rule to identify febrile infants (60 days and younger) at low risk for SBIs presenting at 26 emergency departments (between March 2011 and May 2013) All infants had blood and urine cultures, while cerebrospinal fluid testing was performed at the discretion of the treating clinician. A urinary tract infection (UTI) was defined as the growth of a single urine pathogen with at least 1,000 cfu/mL for cultures obtained by suprapubic aspiration, at least 50,000 cfu/mL from catheterized specimens, or 10,000 to 50,000 cfu/mL from catheterized specimens in association with an abnormal urinalysis. From the 1,821 infants, 908 were randomized to the development cohort and 913 to the […]