Faculty Collaboration Database

Invasive Bacterial Infections in Afebrile Infants Diagnosed With Acute Otitis Media. Pediatrics 2021 Jan;147(1)

Date

12/09/2020

Pubmed ID

33288730

DOI

10.1542/peds.2020-1571

Scopus ID

2-s2.0-85099326498 (requires institutional sign-in at Scopus site)   4 Citations

Abstract

OBJECTIVES: To determine the prevalence of invasive bacterial infections (IBIs) and adverse events in afebrile infants with acute otitis media (AOM).

METHODS: We conducted a 33-site cross-sectional study of afebrile infants ≤90 days of age with AOM seen in emergency departments from 2007 to 2017. Eligible infants were identified using emergency department diagnosis codes and confirmed by chart review. IBIs (bacteremia and meningitis) were determined by the growth of pathogenic bacteria in blood or cerebrospinal fluid (CSF) culture. Adverse events were defined as substantial complications resulting from or potentially associated with AOM. We used generalized linear mixed-effects models to identify factors associated with IBI diagnostic testing, controlling for site-level clustering effect.

RESULTS: Of 5270 infants screened, 1637 met study criteria. None of the 278 (0%; 95% confidence interval [CI]: 0%-1.4%) infants with blood cultures had bacteremia; 0 of 102 (0%; 95% CI: 0%-3.6%) with CSF cultures had bacterial meningitis; 2 of 645 (0.3%; 95% CI: 0.1%-1.1%) infants with 30-day follow-up had adverse events, including lymphadenitis (1) and culture-negative sepsis (1). Diagnostic testing for IBI varied across sites and by age; overall, 278 (17.0%) had blood cultures, and 102 (6.2%) had CSF cultures obtained. Compared with infants 0 to 28 days old, older infants were less likely to have blood cultures (P < .001) or CSF cultures (P < .001) obtained.

CONCLUSION: Afebrile infants with clinician-diagnosed AOM have a low prevalence of IBIs and adverse events; therefore, outpatient management without diagnostic testing may be reasonable.

Author List

McLaren SH, Cruz AT, Yen K, Lipshaw MJ, Bergmann KR, Mistry RD, Gutman CK, Ahmad FA, Pruitt CM, Thompson GC, Steimle MD, Zhao X, Schuh AM, Thompson AD, Hanson HR, Ulrich SL, Meltzer JA, Dunnick J, Schmidt SM, Nigrovic LE, Waseem M, Velasco R, Ali S, Cullen DL, Gomez B, Kaplan RL, Khanna K, Strutt J, Aronson PL, Taneja A, Sheridan DC, Chen CC, Bogie AL, Wang A, Dayan PS, PEDIATRIC EMERGENCY MEDICINE COLLABORATIVE RESEARCH COMMITTEE

Author

Abigail M. Schuh MD Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Anti-Bacterial Agents
Bacteremia
Canada
Cross-Sectional Studies
Drug Utilization
Emergency Service, Hospital
Female
Hospitalization
Humans
Infant
Infant, Newborn
Lymphadenitis
Male
Meningitis, Bacterial
Otitis Media
Spain
United States