TY - JOUR
T1 - Risk of Bacterial Coinfections in Febrile Infants 60 Days Old and Younger with Documented Viral Infections
AU - Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN)
AU - Mahajan, Prashant
AU - Browne, Lorin R.
AU - Levine, Deborah A.
AU - Cohen, Daniel M.
AU - Gattu, Rajender
AU - Linakis, James G.
AU - Anders, Jennifer
AU - Borgialli, Dominic
AU - Vitale, Melissa
AU - Dayan, Peter S.
AU - Casper, T. Charles
AU - Ramilo, Octavio
AU - Kuppermann, Nathan
AU - Powell, Elizabeth C.
AU - Tunik, Michael G.
AU - Nigrovic, Lise E.
AU - Roosevelt, Genie
AU - Alpern, Elizabeth R.
AU - Saunders, Mary
AU - Atabaki, Shireen M.
AU - Ruddy, Richard M.
AU - Hoyle, John D.
AU - Blumberg, Stephen
AU - Crain, Ellen F.
AU - Bonsu, Bema
AU - Bennett, Jonathan E.
AU - Greenberg, Richard
AU - Jaffe, David M.
AU - Muenzer, Jared
AU - Cruz, Andrea T.
AU - Macias, Charles
AU - Tzimenatos, Leah
AU - Rogers, Alexander J.
AU - Brayer, Anne
AU - Lillis, Kathleen
N1 - Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/12
Y1 - 2018/12
N2 - Objective: To determine the risk of serious bacterial infections (SBIs) in young febrile infants with and without viral infections. Study design: Planned secondary analyses of a prospective observational study of febrile infants 60 days of age or younger evaluated at 1 of 26 emergency departments who did not have clinical sepsis or an identifiable site of bacterial infection. We compared patient demographics, clinical, and laboratory findings, and prevalence of SBIs between virus-positive and virus-negative infants. Results: Of the 4778 enrolled infants, 2945 (61.6%) had viral testing performed, of whom 1200 (48.1%) were virus positive; 44 of the 1200 had SBIs (3.7%; 95% CI, 2.7%-4.9%). Of the 1745 virus-negative infants, 222 had SBIs (12.7%; 95% CI, 11.2%-14.4%). Rates of specific SBIs in the virus-positive group vs the virus-negative group were: UTIs (33 of 1200 [2.8%; 95% CI, 1.9%-3.8%] vs 186 of 1745 [10.7%; 95% CI, 9.2%-12.2%]) and bacteremia (9 of 1199 [0.8%; 95% CI, 0.3%-1.4%] vs 50 of 1743 [2.9%; 95% CI, 2.1%-3.8%]). The rate of bacterial meningitis tended to be lower in the virus-positive group (0.4%) than in the viral-negative group (0.8%); the difference was not statistically significant. Negative viral status (aOR, 3.2; 95% CI, 2.3-4.6), was significantly associated with SBI in multivariable analysis. Conclusions: Febrile infants ≤60 days of age with viral infections are at significantly lower, but non-negligible risk for SBIs, including bacteremia and bacterial meningitis.
AB - Objective: To determine the risk of serious bacterial infections (SBIs) in young febrile infants with and without viral infections. Study design: Planned secondary analyses of a prospective observational study of febrile infants 60 days of age or younger evaluated at 1 of 26 emergency departments who did not have clinical sepsis or an identifiable site of bacterial infection. We compared patient demographics, clinical, and laboratory findings, and prevalence of SBIs between virus-positive and virus-negative infants. Results: Of the 4778 enrolled infants, 2945 (61.6%) had viral testing performed, of whom 1200 (48.1%) were virus positive; 44 of the 1200 had SBIs (3.7%; 95% CI, 2.7%-4.9%). Of the 1745 virus-negative infants, 222 had SBIs (12.7%; 95% CI, 11.2%-14.4%). Rates of specific SBIs in the virus-positive group vs the virus-negative group were: UTIs (33 of 1200 [2.8%; 95% CI, 1.9%-3.8%] vs 186 of 1745 [10.7%; 95% CI, 9.2%-12.2%]) and bacteremia (9 of 1199 [0.8%; 95% CI, 0.3%-1.4%] vs 50 of 1743 [2.9%; 95% CI, 2.1%-3.8%]). The rate of bacterial meningitis tended to be lower in the virus-positive group (0.4%) than in the viral-negative group (0.8%); the difference was not statistically significant. Negative viral status (aOR, 3.2; 95% CI, 2.3-4.6), was significantly associated with SBI in multivariable analysis. Conclusions: Febrile infants ≤60 days of age with viral infections are at significantly lower, but non-negligible risk for SBIs, including bacteremia and bacterial meningitis.
KW - coinfection
KW - febrile infant
KW - serious bacterial infection
KW - viral infection
UR - https://www.scopus.com/pages/publications/85052921249
U2 - 10.1016/j.jpeds.2018.07.073
DO - 10.1016/j.jpeds.2018.07.073
M3 - Article
C2 - 30195552
AN - SCOPUS:85052921249
SN - 0022-3476
VL - 203
SP - 86-91.e2
JO - Journal of Pediatrics
JF - Journal of Pediatrics
ER -