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作者机构:Univ Perugia Dept Surg & Biomed Sci Pediat Clin Perugia Italy Univ Perugia Dept Med Microbiol Unit Perugia Italy Univ Milan Pediat Milan Italy
出 版 物:《MEDIATORS OF INFLAMMATION》 (炎症介体)
年 卷 期:2018年第2018卷第1期
页 面:1-11页
核心收录:
学科分类:0710[理学-生物学] 1002[医学-临床医学] 1001[医学-基础医学(可授医学、理学学位)] 100201[医学-内科学(含:心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学]
基 金:World Association for Infectious Diseases and Immunological Disorders [WAidid 2016_09]
主 题:BACTERIAL disease risk factors NEONATAL diseases FEVER ANTIBIOTICS COMPUTER algorithms
摘 要:Introduction. Among neonates and infants 3 months of age with fever without a source (FWS), 5% to 15% of cases are patients with fever caused by a serious bacterial infection (SBI). To favour the differentiation between low- and high-risk infants, several algorithms based on analytical and clinical parameters have been developed. The aim of this review is to describe the management of young infants with FWS and to discuss the impact of recent knowledge regarding FWS management on clinical practice. Materials and Methods. PubMed was used to search for all of the studies published over the last 35 years using the keywords: fever without source or fever of unknown origin or meningitis or sepsis or urinary tract infection and neonate or newborn or infant 90 days of life or infant 3 months. Results and Discussion. The selection of neonates and young infants who are 3 months old with FWS who are at risk for SBI remains a problem without a definitive solution. The old Rochester criteria remain effective for identifying young infants between 29 and 60 days old who do not have severe bacterial infections (SBIs). However, the addition of laboratory tests such as C-reactive protein (CRP) and procalcitonin (PCT) can significantly improve the identification of children with SBI. The approach in evaluating neonates is significantly more complicated, as their risk of SBIs, including bacteremia and meningitis, remains relevant and none of the suggested approaches can reduce the risk of dramatic mistakes. In both groups, the best antibiotic must be carefully selected considering the clinical findings, the laboratory data, the changing epidemiology, and increasing antibiotic resistance of the most common infectious bacteria.