Management of infants at risk for occult bacteremia

A decision analysis

Stephen Downs, Robert A. McNutt, Peter A. Margolls

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Because febrile infants with no obvious source of bacterial infection may have bacteremia, and because bacteremia is difficult to diagnose on clinical grounds, we used decision analysis to evaluate whether such infants should be treated with antibiotics, tested further, or sent home. Using a simple decision tree, we found that the decision to give empiric antibiotic treatment is the decision of choice. The difference in quality-adjusted life expectancy between the "best" and "worst" decisions was only 11 days. However, this difference translated to prevention of death or permanent disability in 60 cases per 100,000 febrile children. Further, empiric treatment remained the best management alternative unless the probability of bacteremia was less than 1.4% (less than any published prevalence), or the efficacy of treatment was less than 21%. Our analysis demonstrated that a test with far greater sensitivity than leukocyte count or other tests currently in use is needed to justify testing rather than treating empirically. Further, an enormous patient population would be needed to find a difference of both clinical and statistical significance between treated and untreated patients in a controlled trial. In the absence of such trials, we recommend blood culture and empiric antibiotic treatment of all infants at risk for occult bacteremia.

Original languageEnglish (US)
Pages (from-to)11-20
Number of pages10
JournalJournal of Pediatrics
Volume118
Issue number1
DOIs
StatePublished - 1991
Externally publishedYes

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Decision Support Techniques
Bacteremia
Anti-Bacterial Agents
Fever
Decision Trees
Life Expectancy
Leukocyte Count
Bacterial Infections
Therapeutics
Quality of Life
Population

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Management of infants at risk for occult bacteremia : A decision analysis. / Downs, Stephen; McNutt, Robert A.; Margolls, Peter A.

In: Journal of Pediatrics, Vol. 118, No. 1, 1991, p. 11-20.

Research output: Contribution to journalArticle

Downs, Stephen ; McNutt, Robert A. ; Margolls, Peter A. / Management of infants at risk for occult bacteremia : A decision analysis. In: Journal of Pediatrics. 1991 ; Vol. 118, No. 1. pp. 11-20.
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