Fever w/o Source in Infants and Children

Question 1

In a neonate <60 days of age, what is the bacteria most commonly found in bacteremia, meningitis, and osteomyelitis?

Answer 1

Group B Streptococcus and E. Coli

Question 2

In a neonate <60 days of age, what is the bacteria most commonly found in UTI?

Answer 2

E. coli

Question 3

In a neonate <60 days of age, what is the bacteria most commonly found with diarrhea?

Answer 3

Salmonella

Question 4

In children with fever without a source between the ages of 3 and 36 months, when should urine cultures be considered for girls?

Answer 4

All girls <12 months old should have a urine culture sent when presenting with fever without source.

Question 5

In children with fever without a source between the ages of 3 and 36 months, when should urine cultures be considered for boys?

Answer 5

All boys <6 months of age should have a urine culture sent when presenting for fever without a source.

Question 6

What should be the standard workup for all infants <30 days old who present with fever?

Answer 6

Complete H&P, CBC, UA, Blood culture, Urine culture, lumbar puncture with CSF studies, serum glucose (to compare w/ CSF glucose), inflammatory markers (CRP/PCT), CXR only if there are signs of respiratory involvement. HSV studies should be sent if there are concerning findings on history or physical exam.

Question 7

What should be the standard workup for all infants 30-60 days old who present with fever?

Answer 7

Complete H&P, CBC, UA, Blood culture, and Urine culture. If the infant is ill-appearing or has CNS findings on exam, also get lumbar puncture with CSF studies, serum glucose (to compare w/ CSF glucose), and inflammatory markers (CRP/PCT). CXR only if there are signs of respiratory involvement. HSV studies should be sent if there are concerning findings on history or physical exam.

Question 8

What laboratory values must be met for a well-appearing 30-60 day old infant to merit observation off antibiotics rather than the full septic workup with antibiotics?

Answer 8

Normal WBC, absolute band count < 1,500/uL, <11 WBC/HPF on spun urine, and <6 WBC/HPF on stool smear (if diarrhea present).

Question 9

What are the two commonly cited evaluation tools currently in use for evaluation and management of well-appearing febrile infants 28-90 days of age?

Answer 9

PECARN (<60 days old) and the Step-by-step approach (<90 days old).

Question 10

Under what age should C. diff testing not be routinely sent and why not?

Answer 10

C. diff testing should not be performed on children <1 year of age due to high colonization rates without corresponding illness.