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A Systematic Review

Julie C. Brown, MD; Jane L. Burns, MD; Peter Cummings, MD, MPH

Arch Pediatr Adolesc Med. 2002;156:27-32.

Objectives  To estimate the prevalence of perinatal Listeria monocytogenes and enterococcal infections in outpatient febrile infants and to evaluate the need to treat with ampicillin.

Data Sources  Online bibliographies were searched for articles related to serious bacterial infection and fever in infants. Reference lists from selected and review articles were also examined.

Study Selection  Studies that reported rates and types of bacterial infection in febrile outpatients younger than 3 months were included. Those performed outside North America, lacking results by age, or those that evaluated selected patient populations were excluded.

Data Extraction  Two authors independently reviewed the selected articles for inclusion and abstracted the data.

Data Synthesis  Fourteen studies, evaluating 5247 febrile outpatients, were included. The prevalences of L monocytogenes and enterococcal infections were 7.3 (binomial exact 95% confidence interval [CI], 3.5-13.3), 1.9 (95% CI, 0.6-4.4), and 5.6 (95% CI, 0.7-2.1) per 1000 febrile infants in the first, second, and third months of life, respectively. To cover 1 infant with serious bacterial infection caused by L monocytogenes and enterococcal infections, the numbers of febrile infants who would need ampicillin were estimated as 138 (95% CI, 76-288) in the first month, 527 (95% CI, 226-1621) in the second month, and 178 (95% CI, 50-1469) in the third month. Enterococcal infections occurred in all ages studied; there were no Listeria infections after 30 days of age.

Conclusion  The empirical use of ampicillin to cover febrile infants for L monocytogenes and enterococcal infections is most justifiable in the first month of life.

From the Divisions of General Academic Pediatrics (Dr Brown) and Infectious Disease (Dr Burns), Department of Pediatrics, and Department of Epidemiology, School of Public Health and Community Medicine (Dr Cummings), University of Washington School of Medicine, Seattle.

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