Objective To report the performance of clinical practice guidelines (CPG) in the diagnosis of serious/invasive bacterial infections (SBI/IBI) in infants presenting with a fever to emergency care in the UK and Ireland. Two CPGs were from the National Institutes for Health and Care Excellence (NICE guidelines NG51 and NG143) and one was from the British Society for Antimicrobial Chemotherapy (BSAC). Design Retrospective multicentre cohort study. Patients Febrile infants aged 90 days or less attending between the 31 August 2018 to 1 September 2019. Main outcome measures The sensitivity, specificity and predictive values of CPGs in identifying SBI and IBI. Setting Six paediatric Emergency Departments in the UK/Ireland. Results 555 participants were included in the analysis. The median age was 53 days (IQR 32 to 70), 447 (81%) underwent blood testing and 421 (76%) received parenteral antibiotics. There were five participants with bacterial meningitis (1%), seven with bacteraemia (1%) and 66 (12%) with urinary tract infections. The NICE NG51 CPG was the most sensitive: 1.00 (95% CI 0.95 to 1.00). This was significantly more sensitive than NICE NG143: 0.91 (95% CI 0.82 to 0.96, p=0.0233) and BSAC: 0.82 (95% 0.72 to 0.90, p=0.0005). NICE NG51 was the least specific 0.0 (95% CI 0.0 to 0.01), and this was significantly lower than the NICE NG143: 0.09 (95% CI 0.07 to 0.12, p<0.0001) and BSAC: 0.14 (95% CI 0.1 to 0.17, p<0.0001). Conclusion None of the studied CPGs demonstrated ideal performance characteristics. CPGs should be improved to guide initial clinical decision making. Trial registration number [NCT04196192][1]. Data are available in a public, open access repository. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04196192&atom=%2Farchdischild%2F107%2F4%2F329.atom

中文翻译：

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验证英国和爱尔兰急诊科发热婴儿管理的临床实践指南

目的 报告临床实践指南 (CPG) 在英国和爱尔兰对发热婴儿进行紧急护理时诊断严重/侵袭性细菌感染 (SBI/IBI) 的表现。两份 CPG 来自美国国家健康与护理卓越研究所（NICE 指南 NG51 和 NG143），一份来自英国抗菌化疗学会 (BSAC)。设计回顾性多中心队列研究。患者 90 天或以下的发热婴儿在 2018 年 8 月 31 日至 2019 年 9 月 1 日期间就诊。主要结果测量 CPG 在识别 SBI 和 IBI 中的敏感性、特异性和预测值。在英国/爱尔兰设立六个儿科急诊科。结果 555 名参与者被纳入分析。中位年龄为 53 天（IQR 32 至 70），447 人 (81%) 接受了血液检测，421 人 (76%) 接受了肠外抗生素治疗。有 5 名参与者患有细菌性脑膜炎（1%），7 名患有菌血症（1%），66 名（12%）患有尿路感染。NICE NG51 CPG 是最敏感的：1.00（95% CI 0.95 至 1.00）。这比 NICE NG143：0.91（95% CI 0.82 至 0.96，p=0.0233）和 BSAC：0.82（95% 0.72 至 0.90，p=0.0005）明显更敏感。NICE NG51 是特异性最低的 0.0（95% CI 0.0 至 0.01），显着低于 NICE NG143：0.09（95% CI 0.07 至 0.12，p<0.0001）和 BSAC：0.14（95% CI 0.1 至 0.17） , p < 0.0001)。结论 所研究的 CPG 都没有表现出理想的性能特征。应改进 CPG 以指导最初的临床决策。试用注册号 [NCT04196192][1]。数据公开，开放访问存储库。[1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04196192&atom=%2Farchdischild%2F107%2F4%2F329.atom