{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T19:46:21Z","timestamp":1765827981548,"version":"3.41.2"},"reference-count":20,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,1,1]]},"abstract":"<jats:sec><jats:title\/><\/jats:sec><jats:sec><jats:title>OBJECTIVES:<\/jats:title><jats:p>To determine the prevalence of invasive bacterial infections (IBIs) and adverse events in afebrile infants with acute otitis media (AOM).<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>We conducted a 33-site cross-sectional study of afebrile infants \u226490 days of age with AOM seen in emergency departments from 2007 to 2017. Eligible infants were identified using emergency department 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 substantial complications resulting from or potentially associated with AOM. We used generalized linear mixed-effects models to identify factors associated with IBI diagnostic testing, controlling for site-level clustering effect.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>Of 5270 infants screened, 1637 met study criteria. None of the 278 (0%; 95% confidence interval [CI]: 0%\u20131.4%) infants with blood cultures had bacteremia; 0 of 102 (0%; 95% CI: 0%\u20133.6%) with CSF cultures had bacterial meningitis; 2 of 645 (0.3%; 95% CI: 0.1%\u20131.1%) infants with 30-day follow-up had adverse events, including lymphadenitis (1) and culture-negative sepsis (1). Diagnostic testing for IBI varied across sites and by age; overall, 278 (17.0%) had blood cultures, and 102 (6.2%) had CSF cultures obtained. Compared with infants 0 to 28 days old, older infants were less likely to have blood cultures (P &amp;lt; .001) or CSF cultures (P &amp;lt; .001) obtained.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION:<\/jats:title><jats:p>Afebrile infants with clinician-diagnosed AOM have a low prevalence of IBIs and adverse events; therefore, outpatient management without diagnostic testing may be reasonable.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.2020-1571","type":"journal-article","created":{"date-parts":[[2020,12,7]],"date-time":"2020-12-07T13:50:27Z","timestamp":1607349027000},"source":"Crossref","is-referenced-by-count":6,"title":["Invasive Bacterial Infections in Afebrile Infants Diagnosed With Acute Otitis Media"],"prefix":"10.1542","volume":"147","author":[{"given":"Son H.","family":"McLaren","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New 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Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rakesh D.","family":"Mistry","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, School of Medicine, University of Colorado and Children\u2019s Hospital Colorado, Aurora, Colorado;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colleen K.","family":"Gutman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Emory University, Atlanta, Georgia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fahd A.","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher M.","family":"Pruitt","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Alabama, Birmingham, Alabama;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Graham C.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Calgary and Alberta Children\u2019s Hospital, Calgary, Alberta, Canada;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew D.","family":"Steimle","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Emergency Medicine, School of Medicine, University of Utah, Salt Lake City, Utah;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xian","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Emergency Medicine, Children\u2019s National Health System, Washington, DC;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abigail M.","family":"Schuh","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy 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of Pediatrics, University of Pittsburgh Medical Center Children\u2019s Hospital of Pittsburgh, Pittsburgh, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzanne M.","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lise E.","family":"Nigrovic","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad","family":"Waseem","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Emergency Medicine, Lincoln Medical Center, Bronx, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Velasco","sequence":"additional","affiliation":[{"name":"Pediatric Emergency Unit, Rio 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Washington;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kajal","family":"Khanna","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Stanford University, Stanford, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Strutt","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul L.","family":"Aronson","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ankita","family":"Taneja","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Florida, Jacksonville, Jacksonville, Florida;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David 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