Screening Tools for Early Prediction of Bacteremia in Febrile Children aged 3-36 Months

Jazima Sulaiha, S (2019) Screening Tools for Early Prediction of Bacteremia in Febrile Children aged 3-36 Months. Masters thesis, Madras Medical College, Chennai.

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Abstract

BACKGROUND: Bacteremia has often been studied for its implications on morbidity and mortality in a considerable group of children. AIM AND OBJECTIVES: The primary aim of the study is to determine the diagnostic accuracy of screening tools like Yale observation scale, Total leucocyte count, Neutrophil lymphocyte ratio, Absolute neutrophil count, Platelet count, Mean Platelet volume, Platelet distribution width, Plateletcrit, Red blood cell distribution width, Quantitative serum C reactive protein values for early prediction of bacteraemia in febrile children aged 3-36months. And secondary objective is to provide data on the prevalence of occult bacteraemia in febrile children aged 3-36 months. METHODOLOGY: Study Design - Validation of diagnostic tool. Study Setting - Institute of Child Health and Hospital for Children, Egmore. Study Period - January 2018 to August 2018. Inclusion Criteria: All febrile children aged 3-36 months admitted as inpatients with documented temperature > 38°C (100.4°F). Exclusion Criteria: 1. Children treated with antibiotics with in preceding 7 days. 2. Children received immunisation within preceding 48 hours. 3. Children with immunodeficiency condition or currently on immunosuppressive medication. 4. Children with chronic illness that would be altering the standard approach to fever. 5. Children with catheter in situ (CVP catheter, uro catheter etc.). 6. Legal guardian unable to give consent. 200 admitted patients of age 3-36 months old who satisfied the inclusion criteria were subjected to study after obtaining written informed consent from their parent. Temperature was documented at presentation followed by application of Yale observation scale scores, detailed history taking and clinical examination. Blood samples were collected for required tests and for blood culture. RESULTS: Among the study population,bacteremia was present in 29 samples (14.5%), constituted by Klebsiella sp (27.58%), Escherichia coli (20.68%), MRSA (17.24%), Pseudomonas sp (13.79%) Staphylococcus aureus (13.79%), Streptococcus pneumonia (3.44%) and Streptococcus pyogenes (3.44%). Occult bacteremia was present in 9% of study population. Among all the screening tools, total leucocyte count with cut off of 10,000cells/mm3 (AUC = 0.825, 95% CI 0.732 to 0.917), Neutrophil lymphocyte ratio with cut off of 1.45 (AUC = 0.898, 95% CI 0.834 to 0.963), Absolute Neutrophil count with cut off of 5895 cells /mm3 (AUC = 0.964, 95% CI 0.921 to 1.000), Red blood cell distribution width with cut off of 14.55% (AUC = 0.892, 95% CI 0.810 to 0.974) and Quantitative C reactive protein values with cut off of 8mg/dl (AUC = 0.863, 95% CI 0.775 to 0.951) presented with good predictive validity in predicting bacteremia in this study population. CONCLUSION: In our study, total leucocyte count, Neutrophil lymphocyte ratio, Absolute Neutrophil count, RDW values and Serum CRP values were found to have good predictive validity in predicting bacteremia and hence can be used as early screening tools for suspecting bacteremia in febrile children aged 3-36 months and starting antibiotic therapy, while awaiting for blood culture results.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Screening Tools, Early Prediction, Bacteremia, Febrile Children, aged 3-36 Months.
Subjects: MEDICAL > Paediatrics
Depositing User: Subramani R
Date Deposited: 22 Aug 2019 04:13
Last Modified: 24 Aug 2019 03:01
URI: http://repository-tnmgrmu.ac.in/id/eprint/11092

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