Performance of the Modified Boston and Philadelphia Criteria for Invasive Bacterial Infections.

Autor:	Lyons TW; Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; todd.lyons@childrens.harvard.edu., Garro AC; Departments of Pediatrics and Emergency Medicine, Brown University and Rhode Island Hospital, Providence, Rhode Island., Cruz AT; Sections of Pediatric Emergency Medicine and Pediatric Infectious Diseases, Baylor College of Medicine, Houston, Texas., Freedman SB; Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital and Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada., Okada PJ; Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas., Mahajan P; Departments of Emergency Medicine and Pediatrics, Medical School, University of Michigan, Ann Arbor, Michigan., Balamuth F; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Thompson AD; Departments of Pediatrics and Emergency Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware., Kulik DM; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada., Uspal NG; Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington; and., Arms JL; Department of Pediatrics, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota., Nigrovic LE; Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.
Jazyk:	angličtina
Zdroj:	Pediatrics [Pediatrics] 2020 Apr; Vol. 145 (4). Date of Electronic Publication: 2020 Mar 23.
DOI:	10.1542/peds.2019-3538
Abstrakt:	Background: The ability of the decades-old Boston and Philadelphia criteria to accurately identify infants at low risk for serious bacterial infections has not been recently reevaluated. Methods: We assembled a multicenter cohort of infants 29 to 60 days of age who had cerebrospinal fluid (CSF) and blood cultures obtained. We report the performance of the modified Boston criteria (peripheral white blood cell count [WBC] ≥20 000 cells per mm 3 , CSF WBC ≥10 cells per mm 3 , and urinalysis with >10 WBC per high-power field or positive urine dip result) and modified Philadelphia criteria (peripheral WBC ≥15 000 cells per mm 3 , CSF WBC ≥8 cells per mm 3 , positive CSF Gram-stain result, and urinalysis with >10 WBC per high-power field or positive urine dip result) for the identification of invasive bacterial infections (IBIs). We defined IBI as bacterial meningitis (growth of pathogenic bacteria from CSF culture) or bacteremia (growth from blood culture). Results: We applied the modified Boston criteria to 8344 infants and the modified Philadelphia criteria to 8131 infants. The modified Boston criteria identified 133 of the 212 infants with IBI (sensitivity 62.7% [95% confidence interval (CI) 55.9% to 69.3%] and specificity 59.2% [95% CI 58.1% to 60.2%]), and the modified Philadelphia criteria identified 157 of the 219 infants with IBI (sensitivity 71.7% [95% CI 65.2% to 77.6%] and specificity 46.1% [95% CI 45.0% to 47.2%]). The modified Boston and Philadelphia criteria misclassified 17 of 53 (32.1%) and 13 of 56 (23.3%) infants with bacterial meningitis, respectively. Conclusions: The modified Boston and Philadelphia criteria misclassified a substantial number of infants 29 to 60 days old with IBI, including those with bacterial meningitis. Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. (Copyright © 2020 by the American Academy of Pediatrics.)
Databáze:	MEDLINE
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