Risk of Bacterial Coinfections in Febrile Infants 60 Days Old and Younger with Documented Viral Infections

Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN)

doi:10.1016/j.jpeds.2018.07.073

Risk of Bacterial Coinfections in Febrile Infants 60 Days Old and Younger with Documented Viral Infections

Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN)

Pediatrics

Research output: Contribution to journal › Article › peer-review

56 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	86-91.e2
Journal	journal of pediatrics
Volume	203
DOIs	https://doi.org/10.1016/j.jpeds.2018.07.073
State	Published - Dec 2018

Funding

Supported in part by the Health Resources and Services Administration (H34MCO8509), Emergency Services for Children, and by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health (R01HD062477). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This project is also supported in part by the Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), Emergency Medical Services for Children (EMSC) Network Development Demonstration Program under cooperative agreements U03MC00008, U03MC00001, U03MC00003, U03MC00006, U03MC00007, U03MC22684, and U03MC22685. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the US Government. O.R. received personal fees from HuMabs, Abbvie, Janssen, Medimmune, and Regeneron, and grants from Janssen. The other authors declare no conflicts of interest.

Keywords

coinfection
febrile infant
serious bacterial infection
viral infection

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health

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10.1016/j.jpeds.2018.07.073

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@article{2add49d2b9fd471bbc9c3a1a0437c6fd,

title = "Risk of Bacterial Coinfections in Febrile Infants 60 Days Old and Younger with Documented Viral Infections",

abstract = "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.",

keywords = "coinfection, febrile infant, serious bacterial infection, viral infection",

author = "{Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN)} and Prashant Mahajan and Browne, {Lorin R.} and Levine, {Deborah A.} and Cohen, {Daniel M.} and Rajender Gattu and Linakis, {James G.} and Jennifer Anders and Dominic Borgialli and Melissa Vitale and Dayan, {Peter S.} and Casper, {T. Charles} and Octavio Ramilo and Nathan Kuppermann and Powell, {Elizabeth C} and Levine, {Deborah A.} and Tunik, {Michael G.} and Nigrovic, {Lise E.} and Genie Roosevelt and Prashant Mahajan and Alpern, {Elizabeth R} and Melissa Vitale and Lorin Browne and Mary Saunders and Atabaki, {Shireen M.} and Ruddy, {Richard M.} and Linakis, {James G.} and Hoyle, {John D.} and Dominic Borgialli and Stephen Blumberg and Crain, {Ellen F.} and Jennifer Anders and Bema Bonsu and Cohen, {Daniel M.} and Bennett, {Jonathan E.} and Dayan, {Peter S.} and Richard Greenberg and Jaffe, {David M.} and Jared Muenzer and Cruz, {Andrea T.} and Charles Macias and Nathan Kuppermann and Leah Tzimenatos and Rajender Gattu and Rogers, {Alexander J.} and Anne Brayer and Kathleen Lillis",

note = "Publisher Copyright: {\textcopyright} 2018 Elsevier Inc.",

year = "2018",

month = dec,

doi = "10.1016/j.jpeds.2018.07.073",

language = "English (US)",

volume = "203",

pages = "86--91.e2",

journal = "journal of pediatrics",

issn = "0022-3476",

publisher = "Elsevier Inc.",

}

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 - Levine, Deborah A.

AU - Tunik, Michael G.

AU - Nigrovic, Lise E.

AU - Roosevelt, Genie

AU - Mahajan, Prashant

AU - Alpern, Elizabeth R

AU - Vitale, Melissa

AU - Browne, Lorin

AU - Saunders, Mary

AU - Atabaki, Shireen M.

AU - Ruddy, Richard M.

AU - Linakis, James G.

AU - Hoyle, John D.

AU - Borgialli, Dominic

AU - Blumberg, Stephen

AU - Crain, Ellen F.

AU - Anders, Jennifer

AU - Bonsu, Bema

AU - Cohen, Daniel M.

AU - Bennett, Jonathan E.

AU - Dayan, Peter S.

AU - Greenberg, Richard

AU - Jaffe, David M.

AU - Muenzer, Jared

AU - Cruz, Andrea T.

AU - Macias, Charles

AU - Kuppermann, Nathan

AU - Tzimenatos, Leah

AU - Gattu, Rajender

AU - Rogers, Alexander J.

AU - Brayer, Anne

AU - Lillis, Kathleen

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

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UR - http://www.scopus.com/inward/citedby.url?scp=85052921249&partnerID=8YFLogxK

U2 - 10.1016/j.jpeds.2018.07.073

DO - 10.1016/j.jpeds.2018.07.073

M3 - Article

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AN - SCOPUS:85052921249

SN - 0022-3476

VL - 203

SP - 86-91.e2

JO - journal of pediatrics

JF - journal of pediatrics

ER -

Risk of Bacterial Coinfections in Febrile Infants 60 Days Old and Younger with Documented Viral Infections

Abstract

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