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Journal of Pediatrics, The

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Risk of Bacterial Coinfections in Febrile Infants 60 Days Old and Younger with Documented Viral Infections - 21/11/18

Doi : 10.1016/j.jpeds.2018.07.073 
Prashant Mahajan, MD, MPH, MBA 1, ** , Lorin R. Browne, DO 2, Deborah A. Levine, MD 3, Daniel M. Cohen, MD 4, Rajender Gattu, MD 5, James G. Linakis, MD, PhD 6, Jennifer Anders, MD 7, Dominic Borgialli, DO, MPH 8, Melissa Vitale, MD 9, Peter S. Dayan, MD, MSc 10, T. Charles Casper, PhD 11, Octavio Ramilo, MD 12, Nathan Kuppermann, MD, MPH 13
and the

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

  List of additional members of the FIWG PECARN is available at www.jpeds.com (Appendix).
Elizabeth C. Powell, MD, MPH 14, Deborah A. Levine, MD 15, Michael G. Tunik, MD 15, Lise E. Nigrovic, MD, MPH 16, Genie Roosevelt, MD 17, Prashant Mahajan, MD, MPH, MBA 18, Elizabeth R. Alpern, MD, MSCE 19, Melissa Vitale, MD 20, Lorin Browne, DO 21, Mary Saunders, MD 21, Shireen M. Atabaki, MD, MPH 22, Richard M. Ruddy, MD 23, James G. Linakis, MD, PhD 24, John D. Hoyle, MD 25, Dominic Borgialli, DO, MPH 26, Stephen Blumberg, MD 27, Ellen F. Crain, MD, PhD 27, Jennifer Anders, MD 28, Bema Bonsu, MD 29, Daniel M. Cohen, MD 29, Jonathan E. Bennett, MD 30, Peter S. Dayan, MD, MSc 31, Richard Greenberg, MD 32, David M. Jaffe, MD 33, Jared Muenzer, MD 33, Andrea T. Cruz, MD, MPH 34, Charles Macias, MD 34, Nathan Kuppermann, MD, MPH 35, Leah Tzimenatos, MD 35, Rajender Gattu, MD 36, Alexander J. Rogers, MD 37, Anne Brayer, MD 38, Kathleen Lillis, MD 39
14 Ann & Robert H. Lurie Children's Hospital 
15 Bellevue Hospital Center 
16 Boston Children's Hospital 
17 Children's Hospital of Colorado 
18 Children's Hospital of Michigan 
19 Children's Hospital of Philadelphia 
20 Children's Hospital of Pittsburgh 
21 Children's Hospital of Wisconsin 
22 Children's National Medical Center 
23 Cincinnati Children's Hospital Medical Center 
24 Hasbro Children's Hospital 
25 Helen DeVos Children's Hospital 
26 Hurley Medical Center 
27 Jacobi Medical Center 
28 Johns Hopkins Children's Center 
29 Nationwide Children's Hospital 
30 Nemours/Alfred I. DuPont Hospital for Children 
31 New York Presbyterian-Morgan Stanley Children's Hospital 
32 Primary Children's Medical Center 
33 St. Louis Children's Hospital 
34 Texas Children's Hospital 
35 University of California Davis Health 
36 University of Maryland 
37 University of Michigan 
38 University of Rochester 
39 Women and Children's Hospital of Buffalo 

1 Department of Emergency Medicine, University of Michigan, Ann Arbor, MI 
2 Department of Pediatrics and Emergency Medicine, Children's Hospital of Wisconsin, Medical College of Wisconsin, Wauwatosa, WI 
3 Department of Emergency Medicine and Pediatrics, Bellevue Hospital New York University Langone Medical Center, Bellevue Hospital Center, New York, NY 
4 Section of Emergency Medicine, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH 
5 Division of Emergency Medicine, Department of Pediatrics, University of Maryland Medical Center, Baltimore, MD 
6 Department of Emergency Medicine and Pediatrics, Hasbro Children's Hospital and Brown University, Providence, RI 
7 Department of Pediatrics, Johns Hopkins University, Baltimore, MD 
8 Department of Emergency Medicine, Hurley Medical Center and University of Michigan, Flint, MI 
9 Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA 
10 Division of Emergency Medicine, Department of Pediatrics, Columbia University College of Physicians & Surgeons, New York, NY 
11 Department of Pediatrics, University of Utah, Salt Lake City, UT 
12 Division of Pediatric Infectious Diseases and Center for Vaccines and Immunity, Nationwide Children's Hospital and The Ohio State University, Columbus, OH 
13 Department of Emergency Medicine and Pediatrics, University of California, Davis, School of Medicine and UC Davis Health, Davis, CA 

*Reprint requests: Prashant Mahajan, MD, MPH, MBA, Department of Emergency Medicine, University of Michigan, 1540 E. Hospital Dr, CW 2-737, Ann Arbor, MI 48109-4260.Department of Emergency MedicineUniversity of Michigan1540 E. Hospital DrCW 2-737Ann ArborMI48109-4260

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.

Le texte complet de cet article est disponible en PDF.

Keywords : febrile infant, serious bacterial infection, viral infection, coinfection

Abbreviations : ANC, CSF, ED, PECARN, RSV, SBI, UTI, YOS


Plan


 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.
 Portions of this study were presented as an abstract at the Society for Academic Emergency Medicine National Meeting, May 10-13, 2016, New Orleans, Louisiana.


© 2018  Elsevier Inc. Tous droits réservés.
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Vol 203

P. 86 - décembre 2018 Retour au numéro
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  • Variability in Antibiotic Prescribing for Upper Respiratory Illnesses by Provider Specialty
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