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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Office-based treatment and outcomes for febrile infants with clinically diagnosed bronchiolitis.
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Office-based treatment and outcomes for febrile infants with clinically diagnosed bronchiolitis.

机译：临床诊断为细支气管炎的高热婴儿的办公室治疗和预后。

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OBJECTIVES: The goals were to describe the (1) frequency of sepsis evaluation and empiric antibiotic treatment, (2) clinical predictors of management, and (3) serious bacterial illness frequency for febrile infants with clinically diagnosed bronchiolitis seen in office settings. METHODS: The Pediatric Research in Office Settings network conducted a prospective cohort study of 3066 febrile infants (<3 months of age with temperatures >or=38 degrees C) in 219 practices in 44 states. We compared the frequency of sepsis evaluation, parenteral antibiotic treatment, and serious bacterial illness in infants with and without clinically diagnosed bronchiolitis. We identified predictors of sepsis evaluation and parenteral antibiotic treatment in infants with bronchiolitis by using logistic regression models. RESULTS: Practitioners were less likely to perform a complete sepsis evaluation, urine testing, and cerebrospinal fluid culture and to administer parenteral antibiotic treatment for infants with bronchiolitis, compared with those without bronchiolitis. Significant predictors of sepsis evaluation in infants with bronchiolitis included younger age, higher maximal temperature, and respiratory syncytial virus testing. Predictors of parenteral antibiotic use included initial ill appearance, age of <30 days, higher maximal temperature, and general signs of infant distress. Among infants with bronchiolitis (N = 218), none had serious bacterial illness and those with respiratory distress signs were less likely to receive parenteral antibiotic treatment. Diagnoses among 2848 febrile infants without bronchiolitis included bacterial meningitis (n = 14), bacteremia (n = 49), and urinary tract infection (n = 167). CONCLUSIONS: In office settings, serious bacterial illness in young febrile infants with clinically diagnosed bronchiolitis is uncommon. Limited testing for bacterial infections seems to be an appropriate management strategy.
机译：目的：目标是描述（1）败血症评估和经验性抗生素治疗的频率，（2）管理的临床预测因素，以及（3）在办公室环境中发现的临床诊断为细支气管炎的高热婴儿的严重细菌疾病发生率。方法：“儿科研究办公室”网络在44个州的219个实践中对3066名发热婴儿（<3个月大，体温≥38摄氏度）进行了前瞻性队列研究。我们比较了有无临床细支气管炎婴儿的败血症评估，肠胃外抗生素治疗和严重细菌性疾病的发生频率。通过使用逻辑回归模型，我们确定了毛细支气管炎婴儿败血症评估和肠胃外抗生素治疗的预测因子。结果：与没有毛细支气管炎的婴儿相比，从业者不太可能对患有毛细支气管炎的婴儿进行完整的脓毒症评估，尿液测试和脑脊液培养，以及肠胃外抗生素治疗。毛细支气管炎婴儿败血症评估的重要预测指标包括年龄较小，最高体温升高和呼吸道合胞病毒检测。肠胃外使用抗生素的预测因素包括生病初期，年龄<30天，最高温度升高和婴儿窘迫的一般症状。在毛细支气管炎婴儿（N = 218）中，没有人患有严重的细菌性疾病，有呼吸窘迫症状的婴儿接受肠胃外抗生素治疗的可能性较小。在2848名无毛细支气管炎的高热婴儿中，诊断包括细菌性脑膜炎（n = 14），菌血症（n = 49）和尿路感染（n = 167）。结论：在办公室环境中，临床诊断为细支气管炎的高热婴儿严重细菌性疾病并不常见。对细菌感染进行有限的检测似乎是一种适当的管理策略。

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