Frequency of serious bacterial infections in young infants with and without viral respiratory infections

Greenfield, Bryan; Lowery, Briauna; Starke, Hannah; Mayorquin, Lesby; Stanford, Chelsea; Camp, Elizabeth A.; Cruz, Andrea T.

doi:10.1016/j.ajem.2021.09.069

Cited by 12 publications

(7 citation statements)

References 21 publications

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“… 12 Studies have confirmed that the risk of concurrent SBIs in infants with proven viral RTIs is lower than in infants without viral RTIs. 7 , 8 , 12 , 13 , 17 , 18 The findings of our study are in line with other research as no cases with bacteremia or bacterial meningitis were found, and 6.5% of the patients had a UTI.…”

Section: Discussionsupporting

confidence: 92%

The prevalence of serious bacterial infections in infants 90 days and younger with viral respiratory tract infections

Almojali

Alshareef

Aljadoa

et al. 2022

SMJ

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Objectives: To determine the prevalence and risk factors of serious bacterial infections (SBIs) in infants 90 days and younger with a confirmed respiratory tract infection (RTI). Methods:A retrospective cross-sectional study was carried out of infants 90 days and younger who were admitted to King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia, from January 2019 to December 2020, with polymerase chain reaction (PCR)-proven RTI. Cultures from the urine, blood, and cerebrospinal fluid were reviewed with the patients' demographic information and clinical presentation. Original ArticleResults: Of 322 patients with a viral RTI, 21 (6.5%) had a concurrent urinary tract infection (UTI), and no patients had bacteremia or bacterial meningitis. The risk of a concurrent SBI was 4 times higher in neonates (odds ratio [OR]=4.66, 95% confidence interval [CI]: [1. 32-16.47]). Previously healthy infants were at lower risk to have a SBI in comparison to those with chronic diseases or renal abnormalities (OR=0.23, 95% CI: [0.09-0.61]). In addition, male gender (OR=3.49, 95% CI: [1. 07-11.38]) and abnormal urinalysis (OR=4.12, 95% CI: [1. 48-11.42]) were predictors of SBIs. There was no statistically significant association between the number or type of detected viruses and SBIs. Conclusion:No cases of invasive bacterial infections were found in infants with PCR-proven viral RTIs. There is a risk of having a concurrent UTI in this cohort of patients. Neonates had a higher risk of UTIs as compared to older infants.

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Section: Discussionsupporting

confidence: 92%

The prevalence of serious bacterial infections in infants 90 days and younger with viral respiratory tract infections

Almojali

Alshareef

Aljadoa

et al. 2022

SMJ

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“…In the study mentioned earlier, RSV was also the most common virus, detected in 55% of cases; parainfluenza resulted in a positive test in 17% of cases; and influenza A resulted in a positive test in 14% of cases [9]. An interesting theory presented by Greenfield et al is that the frequency of SBIs may be higher in infants with systemic respiratory viruses (such as enterovirus or adenovirus, which may cause viremia) compared to those with viruses that remain in the respiratory mucosa (influenza, RSV, HMPV, and parainfluenza) [9]. We did not encounter cases of SBIs in patients with RSV, influenza A, or adenovirus, but the small numbers preclude any further conclusions.…”

Section: Discussionmentioning

confidence: 71%

“…In a retrospective cross-sectional study, the total rate of SBIs was 13.9%, and it was 77% lower in those with a documented viral infection. While the risk of bacteremia and UTIs was found to be lower, the number of cases of meningitis was too small for a difference to be detected [9]. In a multi-center prospective study, the rate of SBIs in influenza-positive patients was 2.5% and was significantly lower compared to influenza-negative patients.…”

Section: Discussionmentioning

confidence: 84%

The Impact of Respiratory Symptoms on the Risk of Serious Bacterial Infection in Febrile Infants < 60 Days Old

Masarweh

Toukan

Bar‐Yoseph

et al. 2023

JCM

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Objectives: We aimed to evaluate the impact of respiratory symptoms and positive viral testing on the risk of serious bacterial infections (SBIs). Methods: A retrospective study was conducted that included infants (0–60 days) presenting with a fever between 2001 and 2022 at a tertiary hospital in northern Israel. Demographic, clinical, and laboratory parameters were collected, and risk factors for SBIs were analyzed. Results: Data from a total of 3106 infants, including data from blood, urine, and CSF cultures, were obtained in 96.6%, 89%, and 29% of cases, respectively. A fever without respiratory symptoms (fever only) was present in 1312 infants, while 1794 had a fever and respiratory symptoms—427 were positive for a respiratory virus (virus+), 759 tested negative (virus−), and 608 were not tested. The SBI rate was 5.1% vs. 7.5% in the fever-and-respiratory group vs. the fever-only group (p = 0.004, OR = 0.65 (95% CI = 0.49–0.88)) and 2.8% vs. 7% in the virus+ vs. virus− group (p = 0.002, OR = 0.385, (95% CI = 0.203–0.728)). The male gender, an age < 1 month, leukocytosis > 15 × 109/L, or a CRP > 2 mg/dL increased the risk of SBIs. Respiratory symptoms or a confirmed viral infection reduced the risk of SBIs in the presence of the above risk factors. Conclusions: Respiratory symptoms and a positive viral test decreased the risk of SBIs. Combining rapid viral testing with clinical variables may identify low-risk infants. Despite the relatively low risk of SBIs in individuals with viral infections, conducting prospective studies remains essential for accurately predicting the occurrence of these potentially life-threatening infections.

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“…In line with the low rate of bacterial coinfections in our cohort, others studies showed a signi cantly lower risk for severe infection in febrile infants positive for viral infections compared with virus-negative infants. 20,21 As viral PCR testing for enterovirus, although not available as rapid test, has also shown potential to shorten admission duration and use of antibiotic treatment, evidence-based guidance on the use of viral testing (both rapid and non-rapid methods) should be implemented in the revised FWS guideline. 22 Considering we found a viral cause in our cohort in 41% with low rates of bacterial coinfection, future research efforts in rapid viral testing are needed to decrease ED resource use.…”

Section: Discussionmentioning

confidence: 99%

Prospective multicenter evaluation of adherence to the Dutch guideline for children aged 0 - 16 years with fever without a source - Febrile Illness in Children (FINCH) study

Keuning,

Klarenbeek,

Bout

et al. 2024

Preprint

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Purpose Evaluation of guidelines in actual practice is a crucial step in guideline improvement. Retrospective evaluation of the Dutch guideline for children with fever without an apparent source (FWS) showed 50% adherence in young infants. We prospectively evaluated adherence to the Dutch guideline and its impact on management in current practice. Methods Prospective observational multicenter study, including children three days to sixteen years old presented for FWS at one of seven Emergency Departments in participating secondary and tertiary care hospitals in the Netherlands. Adherence to the Dutch FWS guideline, adapted from the National Institute for Health and Care Excellence (NICE) guideline, was evaluated and patterns in non-adherence and the impact of non-adherence on clinical outcomes and resource use were explored. Results Adherence to the guideline was 192/370 (52%). Adherence was lowest in patients categorized as high risk for severe infection (72/187, 39%), compared to the low risk group (64/73, 88%). Differences in adherence were significant between risk categories (P < 0.001) but not between age categories. In case of non-adherence, less urinalysis, less bacterial cultures (blood, urine and cerebral spinal fluid) and less empirical antibiotic treatment were performed (P < 0.050). Clinical outcomes were not significantly different between the non-adherence and the adherence group, particularly regarding missed severe infections. Conclusions We found a high non-adherence rate of 48%, which did not lead to unfavorable clinical outcomes. This substantiates the need for a critical reevaluation of the FWS guideline and its indications for bacterial cultures, viral testing and antibiotic treatment.

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Frequency of serious bacterial infections in young infants with and without viral respiratory infections

Cited by 12 publications

References 21 publications

The prevalence of serious bacterial infections in infants 90 days and younger with viral respiratory tract infections

The prevalence of serious bacterial infections in infants 90 days and younger with viral respiratory tract infections

The Impact of Respiratory Symptoms on the Risk of Serious Bacterial Infection in Febrile Infants < 60 Days Old

Prospective multicenter evaluation of adherence to the Dutch guideline for children aged 0 - 16 years with fever without a source - Febrile Illness in Children (FINCH) study

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