Clinical Decisionmaking

Sepsis evaluation in hospitalized infants with lower respiratory tract infections varies greatly

Infants 3 months or younger suffering from bronchiolitis, a viral respiratory infection, usually have a fever. Even though evidence suggests a low chance of serious bacterial infection (SBI, sepsis) in feverish infants with bronchiolitis, sepsis evaluation is common and varies substantially among pediatric hospitals, according to a study supported by the Agency for Healthcare Research and Quality (contract 290-95-0042).

After controlling for illness severity, infant age, and pediatric intensive care unit (PICU) stay, 10 hospitals studied varied 46-fold in the likelihood that an infant would undergo a sepsis evaluation (from 13 percent to 84 percent of infants). Only 1.3 percent of infants were found to have SBI. Unnecessary evaluation or treatment for sepsis in infants with bronchiolitis has been shown to lead to increased costs, testing, longer hospital stays, and exposure to antibiotics. In this study, sepsis evaluation resulted in an increase of more than $1,777 in costs and about a 1-day longer PICU stay. These results are based on analysis of the medical records of 303 infants 3 months or younger, who were hospitalized for bronchiolitis in 1995 and 1996 in 1 of 10 pediatric hospitals.

Infants with a sepsis evaluation (175 out of 303) received blood, urine, or cerebrospinal fluid culture or parenteral antibiotics. Sicker and younger infants with higher fevers who received PICU treatment were more likely to be evaluated for sepsis, but the risk of SBI was low even for these infants. The researchers recommend that hospitalized infants with typical bronchiolitis be observed without a sepsis evaluation or antibiotic treatment for atypical signs or symptoms inconsistent with bronchiolitis. If these are present, cultures should be obtained and antibiotic treatment initiated.

More details are in "Variation among 10 pediatric hospitals: Sepsis evaluations for infants with bronchiolitis," by Juli A. Antonow, M.D., M.H.A., Randall J. Smout, M.S., Julie Gassaway, R.N., M.S.N., and others, in the April 2001 Journal of Nursing Care Quality 15(3), pp. 39-49.

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