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Predictors of Clinically Non Specific Bacterial Infection in Febrile Children Less than 3 Years of Age : WBC, ESR and CRP

Journal of the Korean Pediatric Society 2003;46(8):758-762.
Published online August 15, 2003.
Predictors of Clinically Non Specific Bacterial Infection in Febrile Children Less than 3 Years of Age : WBC, ESR and CRP
Jeong A Nho, Young Il Rho, Eun Seuk Yang, Eun Young Kim, Yeong Bong Park, Kyung Rye Moon
Department of Pediatrics, College of Medicine, Chosun University, Gwangju, Korea
비특이적 소견을 보이는 3세 이하의 발열 환아에서 세균성 감염의 예측 인자 : 백혈구 수, 적혈구 침강 속도, C-반응성 단백질
노정아, 노영일, 양은석, 김은영, 박영봉, 문경래
조선대학교 의과대학 소아과학교실
Correspondence: 
Kyung Rye Moon, Email: krmoon@chosun.ac.kr
Abstract
Purpose
: Our examination was designed to determine the diagnostic properties of the cutoff point for the prediction of bacteremia in febrile children less than 3 years of age. Cutoff point is the value that simultaneously maximizes both sensitivity and specificity.
Methods
: We conducted a retrospective study of febrile children, less than 3 years of age, who clinically have no identifiable source of fever. Peripheral blood leukocyte count(WBC), absolute neutrophil count(ANC), erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) were measured at the same time. All patients received blood culture, urine culture and/or CSF culture. Bacterial infection was defined as single pathogen isolated from the CSF or blood or a urinary tract infection (UTI). Patients were dichotomized into two groups : those with bacterial infection and no bacterial infection. We analyzed the characteristics of the children in the two groups.
Results
: Seventy-one patients(44 males; 27 females) were enrolled in the study. Twenty patients (28%) had a serious bacterial infection(twelve urinary tract infection, five bacteremia, three meningitis) and fifty-one(72%) had no serious bacterial infection. WBC, ESR and CRP were significantly different between the two groups(P<0.05). The cutoff point of WBC, ESR and CRP were 20,000/ mm3, 30 mm/hr and 3.0 mg/dL, respectively. The sensitivity and specificity of each cutoff point were WBC(75%, 75%), ESR(79%, 68%) and CRP(83%, 77%), respectively.
Conclusion
: These data show the ability of predictors to identify febrile children less than 3 years of age with bacterial infection. Febrile children who reach the cutoff point must be treated intensively and those who do not reach the cutoff point can be carefully managed without administering antimicrobial agents.
Key Words: Serious bacterial infection, Febrile children, WBC, ESR, CRP


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