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American Academy of Pediatrics
Article

Epidemiology of Bacteremia in Febrile Infants in the United States

Eric Biondi, Rianna Evans, Matthew Mischler, Michael Bendel-Stenzel, Sara Horstmann, Vivan Lee, Jean Aldag and Francis Gigliotti
Pediatrics December 2013, 132 (6) 990-996; DOI: https://doi.org/10.1542/peds.2013-1759
Eric Biondi
aDepartment of Pediatrics, University of Rochester, Rochester, New York;
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Rianna Evans
bThe Children’s Hospital of the King’s Daughters, Norfolk, Virginia;
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Matthew Mischler
cUniversity of Illinois College of Medicine, Peoria, Illinois;
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Michael Bendel-Stenzel
dChildren’s Hospitals and Clinics of Minnesota, Minneapolis, Minnesota;
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Sara Horstmann
eAlbany Medical Center, Albany, New York; and
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Vivan Lee
fChildren’s Hospital of Los Angeles, Los Angeles, California
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Jean Aldag
cUniversity of Illinois College of Medicine, Peoria, Illinois;
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Francis Gigliotti
aDepartment of Pediatrics, University of Rochester, Rochester, New York;
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This article has a correction. Please see:

  • Biondi et al. Epidemiology of Bacteremia in Febrile Infants in the United States. Pediatrics. 2013;132(6):990–996 - April 01, 2014

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Abstract

BACKGROUND: Fever in infants is a common clinical dilemma. The objective of this study was to present data from hospital systems across the northeast, southeast, mid-west, and western United States to identify the pathogens causing bacteremia in febrile infants admitted to general care units.

METHODS: This was a retrospective review of positive blood culture results in febrile infants aged ≤90 days admitted to a general care unit across 6 hospital systems. Data were collected from January 1, 2006 through December 31, 2012 from emergency departments and general inpatient units. Cultures from ICUs, central lines, or infants who had complex comorbidities were excluded, as were repeat cultures positive for the same bacteria. Common contaminants were considered pathogens if they were treated as such.

RESULTS: We identified 181 cases of bacteremia in 177 infants. The most common pathogen was Escherichia coli (42%), followed by group B Streptococcus (23%). Streptococcus pneumoniae was more likely in older infants (P = .01). Non-low-risk bacteremic infants were more likely to have E coli or group B Streptococcus than low-risk bacteremic infants. We identified no cases of Listeria monocytogenes. Variation between sites was minimal.

CONCLUSIONS: This is the largest and most geographically diverse study to date examining the epidemiology of bacteremia in infants. We suggest E coli is the most common cause of bacteremia in previously healthy febrile infants admitted to a general inpatient unit. We identified no cases of L monocytogenes and question whether empirical therapy remains necessary for this pathogen.

  • febrile infant
  • bacteremia
  • Escherichia coli
  • epidemiology
  • antibiotic use
  • Abbreviations:
    AMC —
    Albany Medical Center
    CHCM —
    Children’s Hospitals and Clinics of Minnesota
    CHKD —
    The Children’s Hospital of The King’s Daughters
    CHLA —
    Children’s Hospital Los Angeles
    CHOI —
    Children’s Hospital of Illinois
    CoNS —
    coagulase-negative staphylococcus
    CSF —
    cerebrospinal fluid
    GBS —
    group B Streptococcus
    GCHS —
    Golisano Children’s Hospital at Strong
    SBI —
    serious bacterial infection
    SSTI —
    skin or soft-tissue infection
    UTI —
    urinary tract infection
    • Accepted September 12, 2013.
    • Copyright © 2013 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 132, Issue 6
    1 Dec 2013
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    Epidemiology of Bacteremia in Febrile Infants in the United States
    Eric Biondi, Rianna Evans, Matthew Mischler, Michael Bendel-Stenzel, Sara Horstmann, Vivan Lee, Jean Aldag, Francis Gigliotti
    Pediatrics Dec 2013, 132 (6) 990-996; DOI: 10.1542/peds.2013-1759

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    Epidemiology of Bacteremia in Febrile Infants in the United States
    Eric Biondi, Rianna Evans, Matthew Mischler, Michael Bendel-Stenzel, Sara Horstmann, Vivan Lee, Jean Aldag, Francis Gigliotti
    Pediatrics Dec 2013, 132 (6) 990-996; DOI: 10.1542/peds.2013-1759
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