Van der Velden et al evaluated high-risk pediatric patients with fever. They identified factors associated with bacterial infection. The authors are from multiple institutions in Europe and Africa and are members of the PERFORM consortium.
Patient selection: high-risk child with febrile illness (age < 18 years, immunocompromised, temperature >= 38.0°C). Some patients had febrile neutropenia.
Mortality during febrile illness: 1.9%
Risk factors for bacterial infection:
(1) solid organ transplant (OR 4.7)
(2) HIV positive (OR 7.6)
(3) ill-appearance (OR 3.3)
(4) life-saving interventions required (OR 2.5)
(5) tachypnea (OR 1.8)
(6) tachycardia (OR 1.6)
(7) tacrolimus use (OR 3.4)
Factors associated with non-bacterial cause:
(1) underlying inflammatory condition (OR 0.4)
Differential diagnosis:
(1) viral infection (can be fatal in high-risk patient)
(2) underlying inflammatory disease (requiring immunosuppression)
(3) drug
(4) other
