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This study analyzed the utility of the systemic immune-inflammation index (SII) in predicting serious bacterial infections (SBIs) in infants with fever without a source (FWS). Infants (aged 1–4 months) evaluated in the pediatric emergency department for FWS were divided into two groups: with SBI and without SBI. The efficacy of inflammatory markers in predicting SBI was compared. The study included 223 infants with a mean age of 76.65 ± 25.42 days; 62 (27.8%) of them were included in the SBI group, and all of them were diagnosed with a urinary tract infection (UTI). The hospitalization rate and length of hospital stay were significantly higher in UTI patients (p < 0.001 for each). The mean SII was 795.76 ± 475.85 in the SBI group and 318.24 ± 300.70 in the non-SBI group, and there was a significant difference between the groups (p < 0.001). In diagnosis of SBI, the area under the curve values were found to be 0.89 [95% confidence interval (CI): 0.85–0.94] for C-reactive protein (CRP), 0.86 (95% CI: 0.81–0.91) for absolute neutrophil count (ANC), 0.84 (95% CI: 0.78–0.89) for the SII, and 0.81 (95% CI: 0.74–0.87) for WBC. In the multivariate logistic regression analysis, high CRP and SII values were found to be predictive factors for UTI without bacteremia (p < 0.001 and p = 0.008, respectively). We found that high CRP and SII values could be predictive for UTI without bacteremia in infants with FWS. The SII may be preferred because it can be easily calculated using the hemogram results, is not accompanied by extra costs, and does not require further blood collection. [ABSTRACT FROM AUTHOR]

Fever without a source (FWS) is common clinical status in the young infants. The aim of this study was to evaluate the clinical and laboratory findings of coronavirus disease (COVID-19) infection in well-appearing infants with FWS. Well-appearing febrile infants between 30 and 90 days who were evaluated as FWS in the pediatric emergency department and tested for COVID-19 were divided into two groups: COVID-19 (+) and (−). The clinical and laboratory findings of the patients were compared. The study included 95 febrile infants with FWS, and the mean age was 59.62 ± 16.82 days. The nasopharyngeal COVID-19 polymerase chain reaction test results of 29/95 (30.5%) patients were positive, while 66/95 (69.5%) were negative. The complaints of irritability and nasal congestion were found to be significantly more common in COVID-19-positive patients (p  =   0.04 and p  =   0.041, respectively). The hospitalization rate (p  = 0.009), length of hospital stay (p  = 0.026), initiation of antibiotic treatment (p  < 0.001) and duration of antibiotic treatment (p  = 0.036) were significantly lower in the COVID-19 (+) patients. The C-reactive protein (CRP, p  < 0.001), absolute neutrophil count (ANC, p  < 0.001), absolute lymphocyte count (ALC, p  = 0.015), white blood cell (WBC, p  < 0.001) and systemic immune-inflammation index (SII, p  < 0.001) were found to be significantly lower in the COVID-19 (+) patient group. There was no significant difference between the groups in terms of neutropenia, lymphopenia or leukopenia.   COVID-19 infection may present as an FWS. During the pandemic period, testing for COVID-19 among infants who were evaluated as FWS may reduce unnecessary hospitalizations and antibiotic treatments, and shorten hospital stays and duration of antibiotics. [ABSTRACT FROM AUTHOR]

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