Low prevalence of invasive bacterial infection in febrile infants under 3 months of age with enterovirus infection.

Infants under 3 months of age with fever without source (FWS) generally undergo a full, invasive septic evaluation to exclude invasive bacterial infection (IBI). Enterovirus (EV) infections are mostly banal and self-limiting and show a high prevalence rate at this age. We aimed to investigate the prevalence of IBI in EV-infected and uninfected infants under 3 months of age with FWS. This was a prospective observational cohort study of infants aged <90 days who were admitted because of FWS. As per protocol, blood and urine analysis and culture were obtained in all cases, and RNA EV from blood and/or cerebrospinal fluid samples was determined by real-time PCR. Three hundred and eighty-one previously healthy infants with FWS were included. EV infection was diagnosed in 64 children (16.8%; 95% confidence interval, 13.2-20.9%) and showed an uneventful evolution in all cases. Laboratory markers of infection were consistently lower in EV-infected patients; only one case of IBI (1.6%) was observed in an EV-infected patient as compared with 25.2% in EV-negative infants (p <0.001). Intravenous antibiotic use and length of stay were no different in EV-infected and uninfected patients. In our study, febrile infants (<90 days) diagnosed with EV infection showed a low risk of IBI when compared with uninfected patients. The systematic investigation of EV infection in young infants with FWS may allow a more conservative approach to the management of these patients. Further studies on this diagnostic approach are needed.

[Acute bronchiolitis clinical practice guideline: recommendations for clinical practice]. / Guía de práctica clínica sobre la bronquiolitis aguda: recomendaciones para la práctica clínica.

There are scientific controversies about the management of acute bronchiolitis that generate a great variability in the approach to this entity. A clinical practice guideline (CPG) is a set of systematically developed recommendations to assist practitioners and patients to make decisions based on evidence. A working group (WG) of experts has been selected and they have developed the clinical questions. A systematic search for evidence on the acute bronchiolitis has been done and the evidence has been assessed. The information obtained has been summarized in evidence tables and recommendations have been done from them. The WG has produced a total of 46 clinical questions grouped into sections (diagnosis, complementary tests, treatment, monitoring, prevention and evolution), resulting in 133 recommendations. The CPG on acute bronchiolitis provides an opportunity to unify clinical practice based on scientific evidence, which could rationalize the use of health resources, improving health care quality and equity of access to services.

[Acute bronchiolitis clinical practice guidelines: Description of the metodological process]. / Guía de práctica clínica sobre la bronquiolitis aguda: descripción de la metodología utilizada.

A clinical practice guideline (CPG) is a set of systematically developed recommendations to assist practitioners and patient decisions about appropriate health care, and to select the most appropriate diagnostic or therapeutic options to address a health problem or a specific clinical condition. Acute bronchiolitis is the most common lower respiratory tract infection in infants. In spite of its high prevalence, there is still controversy regarding its management. Therefore bronchiolitis is selected for the development of a CPG. We describe the methodological process used to develop the CPG on acute bronchiolitis.