P0511 - Invasive Bacterial Infections and Adverse Events in Afebrile Infants with Acute Otitis Media

Objectives
To determine the prevalence of invasive bacterial infections (IBIs) and adverse events in afebrile infants with acute otitis media (AOM). Our secondary aim was to describe patterns of diagnostic testing and factors associated with those patterns.

Methods
We conducted a 33-site cross-sectional study of afebrile infants ≤90 days of age with AOM seen in emergency departments (EDs) from 2007 to 2017. Eligible infants were identified using ED diagnosis codes and confirmed by chart review. IBIs (bacteremia and meningitis) were determined by the growth of pathogenic bacteria in blood or cerebrospinal fluid (CSF) culture. Adverse events were defined as any substantial complications resulting from or potentially associated with AOM. We used generalized linear mixed-effects models to compare the odds of IBI diagnostic testing, controlling for site-level clustering effect.

Results
Of 5270 infants screened, 1690 met study criteria (Table 1). One of 285 (0.4%; 95% CI 0-1.9%) infants with blood cultures had bacteremia; 0/103 (0%; 95% CI 0-3.5%) with CSF cultures had bacterial meningitis; 3/667 (0.5%; 95% CI 0.1-1.3%) infants with 30-day follow up had adverse events, including preauricular abscess (1), lymphadenitis (1), and culture-negative sepsis (1) (Table 2). Diagnostic testing for IBI varied across sites and by age; overall, 285 (16.9%) had blood cultures and 103 (6.1%) had CSF cultures obtained. Compared to infants 0-28 days old, older infants were less likely to have blood cultures (P<0.001) or CSF cultures (P<0.001) obtained.

Conclusion
Afebrile infants with AOM have a low prevalence of IBI and adverse events; therefore, outpatient management without diagnostic testing may be reasonable.

Presenting Author(s)

Son McLaren

Assistant Professor of Emergency Medicine in Pediatrics
Columbia University College of Surgeons and Physicians
New York, New York
Disclosure: No Financial Relationships Disclosed

Co-Author(s)

Andrea T. Cruz

Associate Professor
Baylor College of Medicine
Houston, Texas
Disclosure: American Academy of Pediatrics (Honorarium, Editorial board member)
KY

Kenneth Yen

Associate Professor of Pediatrics and Pediatric Emergency Medicine Fellowship Director
University of Texas Southwestern
Dallas, Texas
Disclosure: No Financial Relationships Disclosed
ML

Matthew J. Lipshaw

Clinical Fellow
Cincinnati Children's Hospital Medical Center
Cincinnatti, Ohio
Disclosure: No Financial Relationships Disclosed
Kelly R. Bergmann

Physician, Emergency Research Director, Pediatric Emergency Medicine
Children's Minnesota
Minneapolis, Minnesota
Disclosure: No Financial Relationships Disclosed
Rakesh D. Mistry

Professor of Pediatrics
University of Colorado School of Medicine, Children's Hospital Colorado
Denver, Colorado
Disclosure: No Financial Relationships Disclosed
CG

Colleen K. Gutman

Fellow
Emory University
Atlanta, Georgia
Disclosure: No Financial Relationships Disclosed
FA

Fahd A. Ahmad

Assistant Professor of Pediatrics
Washington University School of Medicine
St. Louis, Missouri
Disclosure: No Financial Relationships Disclosed
Christopher M. Pruitt

Associate Professor of Pediatrics
Medical University of South Carolina
Mount Pleasant, South Carolina
Disclosure: No Financial Relationships Disclosed
GT

Graham C. Thompson

Assistant Professor, Pediatrics and Emergency Medicine
University of Calgary, Alberta Children's Hospital
Calgary, Alberta, Canada
Disclosure: No Financial Relationships Disclosed
MS

Matthew D. Steimle

Pediatrics - Assistant Professor (Clinical)
University of Utah School of Medicine
Salt Lake City, Utah
Disclosure: No Financial Relationships Disclosed
Xian Zhao

Assistant Professor of Pediatrics and Emergency Medicine
Children's National Health System
Washington, District of Columbia
Disclosure: No Financial Relationships Disclosed
AS

Abigail M. Schuh

Assistant Professor
Medical College of Wisconsin
Milwaukee, Wisconsin
Disclosure: No Financial Relationships Disclosed
Amy D. Thompson

Pediatric Emergency Medicine Attending Physician.
Division of Emergency Medicine. Department of Pediatrics. Nemours Alfred I. Hospital For Children.
Wilmington, Delaware
Disclosure: No Financial Relationships Disclosed
HH

Holly R. Hanson

Assistant Professor of Clinical Pediatrics
Monroe Carell Jr. Children's Hospital at Vanderbilt
Nashville, Tennessee
Disclosure: No Financial Relationships Disclosed
SU

Stacey L. Ulrich

Associate Clinical Professor
Rady Children's Hospital San Diego
San Diego, California
Disclosure: No Financial Relationships Disclosed
JM

James A. Meltzer

Associate Professor of Pediatrics
Jacobi Medical Center
Bronx, New York
Disclosure: No Financial Relationships Disclosed
Jennifer Dunnick

Pediatric Emergency Medicine physician
UPMC Children's Hospital of Pittsburgh
Pittsburgh, Pennsylvania
Disclosure: No Financial Relationships Disclosed
SS

Suzanne M. Schmidt

Assistant Professor
Northwestern University Feinberg School of Medicine
Chicago, Illinois
Disclosure: No Financial Relationships Disclosed
LN

Lise E. Nigrovic

Associate Professor in Pediatrics and Emergency Medicine
Boston Children's Hospital
Boston, Massachusetts
Disclosure: No Financial Relationships Disclosed
Muhammad Waseem

Research Director, Emergency Medicine/Pediatrics
Lincoln Medical Center, Bronx, New York
Bronx, New York
Disclosure: No Financial Relationships Disclosed
RV

Roberto Velasco Zuniga

Pediatric Emergency Medicine Physician
Rio Hortega Universitary Hospital
Valladolid, Castilla y Leon, Spain
Disclosure: No Financial Relationships Disclosed
Samina Ali

Professor of Pediatrics & Emergency Medicine
University of Alberta
Edmonton, Alberta, Canada
Disclosure: No Financial Relationships Disclosed
Danielle L. Cullen

Clinical Instructor of Pediatrics
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure: No Financial Relationships Disclosed
Borja Gomez

Pediatric Emergency Medicine Physician
Cruces University Hospital
Barakaldo, Pais Vasco, Spain
Disclosure: No Financial Relationships Disclosed
Ron L. Kaplan

Associate Professor of Pediatrics
University of Washington School of Medicine, Seattle Children's Hospital
Seattle, Washington
Disclosure: No Financial Relationships Disclosed
KK

Kajal Khanna

Clinical Assistant Professor
Stanford University
Stanford, California
Disclosure: No Financial Relationships Disclosed
JS

Jonathan Strutt

Assistant Professor
University of Minnesota
Minneapolis, Minnesota
Disclosure: No Financial Relationships Disclosed
Paul L. Aronson

Associate Professor of Pediatrics and of Emergency Medicine
Yale School of Medicine
New Haven, Connecticut
Disclosure: No Financial Relationships Disclosed
AT

Ankita Taneja

PEM Fellow
University of Florida- Jacksonville
Jacksonville, Florida
Disclosure: No Financial Relationships Disclosed
DS

David C. Sheridan

Assistant Professor of Emergency Medicine/Pediatrics
Oregon Health & Science University
Portland, Oregon
Disclosure: Promedix Inc (Stockholder/Ownership Interest (excluding diversified mutual funds), Equity stake (co-founder) but no revenue received. Research area: biomedical engineering/emergency care. **No relationship to this abstract**)
CC

Carol C. Chen

Assistant Clinical Professor
University of California San Francisco
San Francisco, California
Disclosure: No Financial Relationships Disclosed
AB

Amanda Bogie

Associate Professor of Pediatrics
University of Oklahoma
Oklahoma City, Oklahoma
Disclosure: No Financial Relationships Disclosed

Senior Author(s)

PD

Peter S. Dayan

Professor of Emergency Medicine in Pediatrics
Columbia University College of Physicians and Surgeons
New York, New York
Disclosure: No Financial Relationships Disclosed