Use Criteria to Manage Febrile Infants in the ED Without Antibiotics

From ACEP:

Screening criteria can predict which febrile infants presenting to an emergency department will not have serious bacterial infections and can be safely discharged home without antibiotics. This conclusion was drawn from a retrospective analysis reported by Dr. Taj Madiwale and colleagues at the southern regional meeting of the American Federation for Medical Research.

The study included 552 infants, aged 29-60 days, who presented to a tertiary care children’s hospital ED between January 2001 and December 2004 with a chief complaint of fever. A fever, defined as 100.4° F or higher rectally, was present in 434 infants.

The inclusion criteria for absence of serious bacterial infection were based on previous research and included the following:
• Well appearance.
• CBC white-cell count of 5,000-20,000/mm3 with a band/neutrophil ratio of less than 0.2.
• Urine specimen with no more than 10 white cells per high power field, and negative for leukocyte esterase and nitrate.
• Cerebrospinal fluid with a white-cell count of less than 10/mm3, a negative gram stain, a glucose level greater than 40 mg/dL, and protein less than 120 mg/dL.

Exclusion criteria were:
• Ill appearance.
• Previous surgery, except circumcision.
• History of antibiotics.
• Immune deficiency syndromes.
• Signs of bacterial infection.

Also on the list of exclusion criteria was previous vaccination, other than hepatitis B, as this could cause a transient fever, said Dr. Madiwale, a pediatric emergency medicine fellow with the Children’s Hospital of Alabama at Birmingham.