376 - The Systemic Inflammatory Response Syndrome is a Limited Predictor of Bacteremia in Pediatric Emergency Department Patients

Poster Number: 376
Publication Number: 376.206

Sara A. Tano, Nicklaus Children’s Hospital, Coral Gables, FL, United States; Naiomi Cohen, Nicklaus Children’s Hospital, Miami, FL, United States; Vincenzo Maniaci, Nicklaus Children’s Hospital, miami, FL, United States; David Lowe, Nicklaus Children’s Hospital, Miami, FL, United States; Juan Lozano, Florida International University Herbert Wertheim College of Medicine, Miami, FL, United States

Background: Bacteremia is an uncommon, but potentially fatal condition occurring in about 1 in 250 febrile children < 5 years old. The utility of the Systemic Inflammatory Response Syndrome (SIRS) criteria has been studied as a predictor of bacteremia in adults. To our knowledge there has yet to be a similar study in pediatrics.

Objective: 1. To determine if SIRS criteria can be used to predict bacteremia in pediatric patients presenting with fever to the Emergency department (ED). 2. To calculate the diagnostic characteristics of SIRS for identifying bacteremia.

Design/Methods: Single institution retrospective cohort study of pediatric patients from 0-21 years old who presented to the ED and had a peripheral blood culture drawn between April 2012 to May 2021. Cultures from central lines and ports were excluded. Cultures growing Coagulase-negative Staphylococci, Corynebacterium, Propionibacterium, Bacillus, Aerococcus and Micrococcus species were considered contaminants. Patients were defined as having SIRS if they met any one of the several combinations of SIRS criteria. The most extreme age specific vital signs during the ED course were used for classification. Multivariate logistic regression was used to measure the association between SIRS and bacteremia while adjusting for potential confounders. The diagnostic characteristics of SIRS for the identification of bacteremia according to the number of criteria met were calculated.

Results: A total of 30,896 patients had peripheral blood cultures drawn in the ED and 14,282 (46.2%) met SIRS criteria. Overall, 439 patients (1.4%) had bacteremia. The adjusted odds ratio (aOR) of bacteremia in patients who had SIRS was 1.58 (95% CI 1.31 to 1.91) (Table 1). The odds of bacteremia increased with the number of SIRS criteria met (2 criteria: aOR 1.37, 95% CI 1.08-1.74; 3 criteria: aOR 1.55, 95% CI 1.2 to 2.0; and 4 criteria: aOR 3.28, 95% CI 2.28 to 4.72) (Table 2). Patients less than 6 weeks of age had the greatest association between SIRS and bacteremia, aOR 2.31, 95% CI 1.22 to 4.38. Overall, the sensitivity of SIRS for identifying bacteremia was 57.6%, specificity 53.9%, positive predictive value 1.8%, negative predictive value 98.9% (Table 3). Sensitivity decreased and specificity increased as the number of SIRS criteria increased.Conclusion(s): SIRS is a predictor of bacteremia in pediatric patients. Having multiple SIRS criteria increased the odds of having bacteremia. However, SIRS is a limited screening tool for bacteremia with a 57.6% sensitivity and 53.9% specificity.
Table 1Unadjusted associations between the presence of SIRS or the baseline characteristics and the outcome (positive blood culture)
Table 2Unadjusted and adjusted odds ratios for the association between SIRS or confounders included in the model and positive blood culture stratifying by the number of items for the diagnosis of SIRS