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Risk of serious bacterial infection low in recently immunized febrile infants

Clinical Question:
What is the risk of a serious bacterial infection in recently immunized febrile infants aged 6 weeks to 12 weeks?

Bottom Line:
Among recently immunized infants, the prevalence of serious bacterial infection (SBI) was significantly lower in those presenting within 24 hours of immunization than in those presenting after 24 hours (0.6% vs 8.9%). The overall risk of a SBI in young febrile infants presenting more than 24 hours after immunization is similar to those without recent immunization. (LOE = 2a)

Reference:
Wolff M, Bachur R. Serious bacterial infection in recently immunized young febrile infants. Acad Emerg Med 2009;16(12):1284-1289.  [PMID:20053249]

Study Design:
Cohort (retrospective)

Setting:
Emergency department

Synopsis:
The prevalence of a SBI in recently immunized young febrile infants is unknown. These investigators retrospectively examined medical records for 1978 consecutive patients, aged 6 weeks to 12 weeks, who met study inclusion criteria and presented to the emergency department of a large academic medical center with a measured temperature greater than 38.0 C (100.4 F). Of these, 213 (10.8%) infants had received immunizations within 72 hours prior to the index encounter. Standard procedure for evaluating febrile infants aged 90 days and younger includes complete blood count, blood culture, urinalysis (UA) with urine culture, and lumbar puncture with cerebrospinal fluid (CSF) analysis and culture. Other tests (eg, chest radiography, stool culture, and so forth) were ordered according to specific clinical criteria. Patients were classified as having a definite SBI with (1) bacterial pathogen isolated in blood; (2) bacterial pathogen in urine with greater than or equal to 50,000 cfu/mL of a pure pathogen or 10,000 to 50,000 cfu/mL with an abnormal UA result; (3) bacterial pathogen isolated in the CSF; (4) chest radiography consistent with pneumonia; or (5) bacterial pathogen isolated in stool culture. Possible SBI was defined as chest radiography possibly consistent with pneumonia or a urine culture yielding 10,000 to 50,000 cfu/mL of a single pathogen and a negative UA result or multiple pathogens with 1 dominant (> 50,000 cfu/mL) pathogen. Two individuals independently reviewed the medical records and classified all outcomes. Differences were resolved by consensus. The overall prevalence of definite and possible SBI was 8.0%. The prevalence of SBI was significantly lower in infants recently immunized within the last 72 hours (3.7% vs 8.5%, respectively). Among recently immunized infants, the prevalence of SBI was significantly lower in those presenting within 24 hours of immunization than in those presenting after 24 hours (0.6% vs 8.9%, respectively). Urinary tract infection was the only SBI occurring in recently immunized infants.

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