IDENTIFICATION OF INFANTS UNLIKELY TO HAVE SERIOUS BACTERIAL-INFECTION ALTHOUGH HOSPITALIZED FOR SUSPECTED SEPSIS
IDENTIFICATION OF INFANTS UNLIKELY TO HAVE SERIOUS BACTERIAL-INFECTION ALTHOUGH HOSPITALIZED FOR SUSPECTED SEPSIS
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DOI：
10.1016/s0022-3476(85)80175-x
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发表时间：
1985-01-01
影响因子：
5.1
通讯作者：
MENEGUS, MA
中科院分区：
文献类型：
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作者：
DAGAN, R;POWELL, KR;MENEGUS, MA
在2年的时间里，对233名3个月以下的婴儿进行了前瞻性研究，以确定体格检查、白色血细胞和红细胞带计数以及尿液分析是否可以识别出不太可能患有严重细菌感染的婴儿。仅研究了先前健康的婴儿（足月出生，无围产期并发症，无既往或基础疾病，无既往抗生素治疗）。233名婴儿中有144名（62%）被认为不太可能有严重的细菌感染，因为他们没有与耳部、软组织或骨骼感染一致的体格检查结果，白细胞数在5000至15,000个白色细胞/mm 3之间，条带数低于1500个/mm 3，尿分析结果正常。89名（38%）婴儿不符合这些标准中的一项或多项，并被归类为严重细菌感染的高风险。低风险组144名婴儿中只有1名（0.7%）发生严重感染，而高风险组89名婴儿中有22名（25%）发生严重感染（P <0.0001）。低风险组中没有婴儿出现菌血症，而高风险组中89名婴儿中有9名（10%）出现菌血症（P <0.0005）。无论是传统的危险因素，如年龄，性别和体温，还是其他体征，症状或实验室检查结果都不能充分预测严重的细菌感染。我们的结论是，以前健康的婴儿小于3个月的急性疾病是不太可能有严重的细菌感染，如果他们没有发现符合耳朵，软组织，或骨骼感染，并有正常的白色血细胞和带状计数和正常的尿液检查结果。
During a 2-year period, 233 infants younger than 3 months were prospectively studied to determine whether physical examination, white blood cell and band count, and urinalysis could identify infants unlikely to have serious bacterial infections. Only previously healthy infants (born at term, no perinatal complications, no previous or underlying diseases, no previous antibiotic therapy) were studied. One hundred forty-four (62%) of the 233 infants were considered unlikely to have serious bacterial infections, because they did not have physical findings consistent with ear, soft tissue, or skeletal infection, had between 5000 and 15,000 white blood cells/mm3, had less than 1500 bands/mm3, and urinalysis yielded normal findings. Eighty-nine (38%) infants did not meet one or more of these criteria and were classified as being at high risk for serious bacterial infection. Only one (0.7%) of the 144 infants in the low-risk group had a serious infection, compared with 22 (25%) of the 89 infants in the high risk group (P < 0.0001). None of the infnats in the low-risk gorup had bacteremia, compared with nine (10%) of the 89 infants in the high-risk group (P < 0.0005). Neither traditional risk factors, such as age, sex, and temperature, nor other signs, symptoms, or laboratory findings were adequate predictors of serious bacterial infection. We conclude that previously healthy infants younger than 3 months with an acute illness are unlikely to have serious bacterial infection if they have no findings consistent with ear, soft tissue, or skeletal infections and have normal white blood cell and band form counts and normal urine findings.