열이 있는 3개월 이하의 영아에서 세균성 감염의 예측에 대한 연구

Abstract

Purpose : This study was to analyze serious bacterial infections in infants younger than three months of age and to review the direction of treatments for these patients. Methods : 378 febrile infants with a rectal temperature ≥38.0℃ visited from Jan. 2001 through Dec. 2002 were retrospectively studied. Infants with the following criteria belonged to the low risk group. WBC 5,000～15,000/mm3, WBC negative in urine stick test and negative for nitirite test, CSF WBC <10/mm3 and negative in CSF gram stain, negative chest X-ray, stool WBC <5/HFP(high power field), and focal infection. If any of the above criteria were not met, they belonged to the high risk group. SBI was defined as a positive culture of urine, blood or CSF. SI was defined as aseptic meningitis or pneumonia including above laboratory tests of SBI. SBI patients were separately compared with two groups, high risk and low risk. Results : Of the 378 infants that were tested 216(57.1%) were in the high risk group and 162(42.9%) in the low risk group. Among 105 SBI(27.8%) and 172 SI(45.5%), there were 98 urinary tract infection(25.2%), 10 bacteremia(2.6%), 2 bacterial meningitis(0.6%), and 77 aseptic meningitis(22.8%). There were 76 SBI(35.2%) from the high risk group and 29 SBI(17.9%) from the low risk group identified. The results of the sensitivity(72.4%), the specificity(48.7%), the negative predictive value(82.1%) and the positive predictive value (35.2%) were calculated. Conclusion : Even though the probability of SBI in the low risk group is insignificant, it should still be considered in febrile infants younger than 3 months of age. I believe the CSF study is necessary because of the moderate high incidence of abnormal finding in our study.