560 - Prevalence and characteristics of bacterial infections in children with prolonged fever and well appearance attending the paediatric emergency department

Publication Number: 2545.560

Eduardo Marín, Consorci Corporació Sanitària Parc Taulí, Barcelona, Catalonia, Spain; Paula Herruzo-Pino, Hospital universitari Parc Tauli, Barcelona, Catalonia, Spain; Alba Vilas-Franquesa, Hospital Universitari Parc Tauli, Terrassa, Catalonia, Spain; Aurora Eslava, Corporació Sanitària Parc Taulí, Sabadell, Catalonia, Spain; Marina Pedrosa-Domínguez, Hospital Parc Tauli, Sabadell, Catalonia, Spain; Maria Inmaculada Romero-Novo, Hospital Parc Tauli, Sabadell, Catalonia, Spain; Viviana Patricia Beltran-Salazar, Hospital Parc Tauli, Sabadell, Catalonia, Spain; Roberto Velasco, Hospital Universitari Parc Taulí, SABADELL, Catalonia, Spain

Background: Most clinical guidelines for fever focus on short-term illnesses, which are usually defined as those lasting less than 3-5 days. Few studies have addressed prolonged febrile episodes, resulting in considerable clinical variability and a significant number of additional investigations in these patients.

Objective: To analyse the prevalence and characteristics of bacterial infections, and assess the diagnostic performance of additional investigations in children with prolonged fever and a well appearance attending a paediatric emergency department.

Design/Methods: Retrospective observational study of well-appearing children ≤18 years presenting between October 2021 and September 2023 with fever ≥38°C lasting ≥5 days. Exclusion criteria: immunodeficiency, chronic conditions increasing infection risk, age < 3 months, antibiotic therapy at presentation, or not well-appearing. Data were collected from electronic records and the Catalan Health System.

Results: Among 88,937 emergency department visits, 11,869 (15.8%) patients with fever were screened, 929 (7.8%) had fever ≥5 days, and 742 (79.9%) met inclusion criteria. Bacterial infections were diagnosed in 117 (15.8%): pneumonia (88, 11.9%), urinary tract infection (19, 2.5%), pharyngotonsillitis (7, 0.9%), and acute gastroenteritis (3, 0.4%). Bacteraemia occurred in 2 (0.26%) patients. Blood tests were done in a subset: complete blood count (45.4%), C-reactive protein (46.6%), procalcitonin (2.3%). Antibiotics were prescribed to 249 (33.6%) patients, including 24.0% without confirmed bacterial infection. Blood cultures were obtained in 44.1% of patients, with two bacteraemia, one due to Streptococcus pneumoniae in a child with complicated pneumonia, and one due to Salmonella poona in an infant with acute gastroenteritis.

Conclusion(s): Among children with prolonged fever and well appearance, serious bacterial infections were not uncommon, but invasive infections were rare. Most bacterial diagnoses were based on imaging, especially for pneumonia. The diagnostic utility of blood tests was low. Clinical judgement should be combined with selective use of diagnostics.