All issues > Volume 46(8); 2003

Original Article

J Korean Pediatr Soc. 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 JA Nho¹, Young Il YI Rho¹, Eun Seuk ES Yang¹, Eun Young EY Kim¹, Yeong Bong YB Park¹, Kyung Rye KR Moon¹

¹Department of Pediatrics, College of Medicine, Chosun University, Gwangju, Korea

Correspondence Kyung Rye KR 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.

Keywords :Serious bacterial infection, Febrile children, WBC, ESR, CRP