Does extreme leukocytosis predict serious bacterial infections in infants in the post-pneumococcal vaccine era? The experience of a large, tertiary care pediatric hospital.

Abstract:

BACKGROUND:Extreme leukocytosis, defined as a peripheral white blood cell count greater than 25,000/mm, may alarm clinicians and prompt extensive evaluation in infants with fever, especially in the pediatric emergency department. METHODS:We reviewed data from children aged 3 to 36 months with extreme leukocytosis, fever and the risk of serious bacterial infections (SBI) at our institution from July 2010 to December 2012, a period after the universal introduction of pneumococcal vaccine. RESULTS:Serious bacterial infection was recorded in 57 (39%) of the 147 infants. The most common SBI were segmental or lobar pneumonia, in 28 (19%) patients, and urinary tract infection in 16 (10.9%) patients. Three patients had positive blood cultures, corresponding to a bacteremia rate of 2%. C-reactive protein was significantly higher in the SBI group than in the non-SBI group. CONCLUSIONS:All well-looking febrile infants with white blood cell greater than 25,000/mm should undergo a chest radiograph unless there are clear physical findings that indicate a different etiology. Urine culture should be considered in women. C-reactive protein can have an added value in the differential diagnosis.

journal_name

Pediatr Emerg Care

journal_title

Pediatric emergency care

authors

Danino D,Rimon A,Scolnik D,Grisaru-Soen G,Glatstein M

doi

10.1097/PEC.0000000000000454

subject

Has Abstract

pub_date

2015-06-01 00:00:00

pages

391-4

issue

6

eissn

0749-5161

issn

1535-1815

journal_volume

31

pub_type

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