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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Performance of low-risk criteria in the evaluation of young infants with fever: review of the literature.
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Performance of low-risk criteria in the evaluation of young infants with fever: review of the literature.

机译：低风险标准在评估发烧婴儿中的表现：文献综述。

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OBJECTIVE: The goal was to determine the performance of low-risk criteria for serious bacterial illnesses (SBIs) in febrile infants in prospective studies in which empiric antibiotic treatment was withheld, compared with studies (prospective and retrospective) in which empiric antibiotic treatment was administered. METHODS: A search of the English-language literature was undertaken by using a PubMed database and reference lists of relevant studies of fever, low-risk criteria, and SBIs. Studies of infants >90 days of age, infants with specific infections, or infants with additional risk factors for infection were excluded. Publications were categorized as retrospective, prospective with empiric antibiotic treatment for all patients, or prospective with antibiotics withheld. The relative risk of SBI in high-risk versus low-risk patients was determined for pooled data in each category. The rates of SBIs in low-risk patients in each category were compared. RESULTS: Twenty-one studies met the inclusion criteria. In prospective studies in which patients were cared for without empiric antibiotic treatment, 6 patients assigned to the low-risk category had SBIs; all recovered uneventfully. The rate of SBIs in these low-risk patients was 0.67%. The relative risk of SBIs in high-risk versus low-risk patients in these studies was 30.56 (95% confidence interval: 7.0-68.13). The rate of SBIs in low-risk patients in all studies was 2.23%. The rate of SBIs in low-risk patients in the prospective studies without empiric antibiotic treatment was significantly different from the rate in all other studies (0.67% vs 2.71%; P = .01). CONCLUSIONS: Low-risk criteria perform well in prospective studies in which empiric antibiotic treatment is withheld. These criteria allow approximately 30% of young febrile infants to be observed without antibiotic treatment, thus avoiding unnecessary hospitalization, nosocomial infection, injudicious use of antibiotics, and adverse effects of antibiotics.
机译：目的：与应用经验性抗生素治疗的研究（前瞻性和回顾性研究）相比，目的是确定在不进行经验性抗生素治疗的前瞻性研究中，高热婴儿的严重细菌性疾病（SBI）低风险标准的表现。方法：使用PubMed数据库和有关发烧，低危标准和SBI的相关研究参考文献进行英语文献检索。排除了对> 90天龄的婴儿，特定感染的婴儿或具有其他感染危险因素的婴儿的研究。出版物分类为回顾性研究，对所有患者进行经验性抗生素治疗或不接受抗生素治疗的前瞻性。对于每个类别中的汇总数据，确定了高危和低危患者的SBI相对风险。比较了每类低危患者的SBI发生率。结果：二十一项研究符合纳入标准。在前瞻性研究中，未经经验性抗生素治疗而接受治疗的患者中，有6名属于低风险类别的患者患有SBI。全部恢复顺利。这些低危患者的SBI发生率为0.67％。在这些研究中，高危和低危患者的SBI相对风险为30.56（95％置信区间：7.0-68.13）。在所有研究中，低危患者的SBI发生率为2.23％。在未进行经验性抗生素治疗的前瞻性研究中，低危患者的SBI发生率与所有其他研究中的发生率显着不同（0.67％对2.71％; P = 0.01）。结论：低风险标准在前瞻性研究中表现良好，而经验性抗生素治疗被禁止。这些标准允许在不进行抗生素治疗的情况下观察到大约30％的高热婴儿，从而避免了不必要的住院，医院感染，抗生素使用不当以及抗生素的不良影响。

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