Descriptive study evaluating the management and outcome of infants aged 21-90 days presenting to a paediatric emergency department with a possible serious bacterial infection
Date
2019-12
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Abstract
Background: Young infants with a possible serious bacterial infection (SBI) are a common
presentation to paediatric emergency departments (PEDs). It is often difficult to distinguish clinically between self-limiting viral infections and a SBI. Available evaluation algorithms to assist clinicians are mostly from high income countries. Data to inform clinical practice in low and middle income countries are lacking.
Objectives: To determine the period prevalence of SBI and invasive bacterial infection (IBI) and
describe current practice in the assessment and management of young infants aged 21-90 days
presenting with a possible SBI to a PED in Cape Town, South Africa.
Methods: A retrospective cross-sectional review of infants 21-90 days old presenting to the
Tygerberg Hospital PED between 1 January 2016 to 31 May 2016.
Results: A total of 248 infants 21-90 days were included in the study. Sixty-two patients (25%,
95% CI 20-30) had a SBI and 13 (5.2%, 95% CI 3-8) had an IBI. One hundred and sixty five
infants had a possible SBI based on IMCI criteria. The sensitivity of the IMCI criteria in
detecting SBI was 82.3% (95% CI 70.5-90.8) and the specificity 38.7% (95% CI 31.7-46.1).
More than half (51.2%) of the infants received antibiotics within the 48 hours prior to
presentation, of which 33.5% included intramuscular injection of Ceftriaxone. Only 20 (8.0%)
patients in this age group were discharged home after initial evaluation. Of the infants who did
not have a SBI, 96 (51.9%) received intravenous antibiotics.
Conclusion:
Period prevalence of SBI and IBI was much higher compared to that published in the literature.
Evaluation algorithms to stratify risk of SBI are needed to assist clinicians in diagnosing and
managing infants appropriately in low and middle income settings.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar
Description
Thesis (MMed)--Stellenbosch University, 2019.
Keywords
Infants, Paediatric, Bacterial infection, Communicable diseases