Sepsis Workup in Febrile Infants 0–90 Days of Age With Respiratory Syncytial Virus Infection

Oray-Schrom, Pinar; Phoenix, Carlene; Martin, Dacelin St; Amoateng-Adjepong, Yaw

doi:10.1097/01.pec.0000092576.40174.28

Cited by 39 publications

(37 citation statements)

References 21 publications

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“…In agreement with previous study results, 21,22 we found low rates of bacterial coinfections in children hospitalized with bronchiolitis. Whereas Purcell et al 21 reported 1.6% positive bacterial cultures, mostly urine cultures, Oray-Schrom et al 22 reported a rate of 7.2%, which was closer to our rate of 6.1% in children hospitalized with RSV bronchiolitis.…”

Section: Discussionsupporting

confidence: 93%

“…Whereas Purcell et al 21 reported 1.6% positive bacterial cultures, mostly urine cultures, Oray-Schrom et al 22 reported a rate of 7.2%, which was closer to our rate of 6.1% in children hospitalized with RSV bronchiolitis. These findings confirm that concurrent bacterial infections are uncommon in children with bronchiolitis and emphasize the need for viral testing to accurately diagnose these patients’ conditions.…”

Section: Discussionsupporting

confidence: 78%

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Risk Factors in Children Hospitalized With RSV Bronchiolitis Versus Non–RSV Bronchiolitis

et al. 2010

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BACKGROUND The trends in hospitalization rates and risk factors for severe bronchiolitis have not been recently described, especially after the routine implementation of prophylaxis for respiratory syncytial virus (RSV) infections. OBJECTIVES To define the burden of hospitalizations related to RSV and non-RSV bronchiolitis in a tertiary-care children’s hospital from 2002 to 2007 and to identify the risk factors associated with severe disease. METHODS Medical records of patients hospitalized for bronchiolitis were reviewed for demographic, clinical, microbiologic, and radiologic characteristics as well as the presence of underlying medical conditions. Differences were evaluated between children with RSV and non-RSV bronchiolitis, and multivariable logistic regression analyses were performed to identify independent risk factors for severe disease. RESULTS Bronchiolitis hospitalizations in children younger than 2 years old (n =4800) significantly increased from 536 (3.3%) in 2002 to 1241 (5.5%) in 2007, mainly because of RSV infections. Patients with RSV bronchiolitis (n = 2840 [66%]) were younger at hospitalization and had a lower percentage of underlying medical conditions than children hospitalized with non-RSV bronchiolitis (27 vs 37.5%; P < .001). However, disease severity defined by length of hospitalization and requirement of supplemental oxygen, intensive care, and mechanical ventilation was significantly worse in children with RSV bronchiolitis. RSV infection and prematurity, regardless of the etiology, were identified as independent risk factors for severe bronchiolitis. CONCLUSIONS There was a significant increase in hospitalizations for RSV bronchiolitis from 2002 to 2007. A majority of the children with RSV bronchiolitis were previously healthy, but their disease severity was worse compared with those hospitalized with non-RSV bronchiolitis.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 78%

Risk Factors in Children Hospitalized With RSV Bronchiolitis Versus Non–RSV Bronchiolitis

et al. 2010

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“…None of these febrile RSV positive patients had bacteremia while 4 (2.5%) had a SBI [92]. Despite the low rates of serious bacterial infection in RSV-positive febrile infants, particularly meningitis and bacteremia, caution should be used in extrapolating the data from these findings in young infants to an exclusive neonatal population since two studies that enrolled RSV-positive febrile neonates 28 days of age did report a 4.9% and 6.1% rate of UTIs [90,91], with one study reporting a 3.7% rate of bacteremia [91]. At the minimum, we recommend obtaining a urine culture in febrile neonates with documented RSV infection.…”

Section: Fever In Neonates With Respiratory Syn-cytial Virusmentioning

confidence: 87%

“…Although no study has exclusively enrolled febrile neonates with documented RSV infection and examined the rate of SBI, Table 5 summarizes recent studies that have examined the rate of SBI in febrile infants where febrile neonates with RSV bronchiolitis were a subset of enrolled patients. Four of the studies [87][88][89][90] were retrospective in design and even though full sepsis evaluations occurred in only approximately 50% of febrile infants [87,88,90], two of the studies did not report a single case of bacteremia [88,89] while the remaining two had bacteremia rates of <1.0% [87,90]. In these four studies there was only a single case of meningitis reported in an RSV-positive infant, a 45 day old who presented with apnea, fever and cyanosis while the rates of UTI ranged from 0 to 7.1%.…”

Section: Fever In Neonates With Respiratory Syn-cytial Virusmentioning

confidence: 99%

Neonatal Fever in the Term Infant: Evaluation and Management Strategies

Myers

Beck²,

Brummel

2008

CPR

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The presence of fever in the neonatal period demands urgent evaluation from healthcare providers since signs and symptoms of a serious bacterial infection in this age group can be nonspecific. Current practice guidelines recommend that febrile neonates should be presumed to have a serious bacterial infection and undergo a sepsis evaluation and hospitalization until the results of diagnostic testing are known. However, less than 50% of outpatient practitioners in a recent study followed these recommendations without apparent adverse outcomes even though the rate of serious bacterial infections in the neonatal period is higher than febrile infants 1-3 months of age. In this article we examine various clinical scenarios that healthcare providers confront when caring for febrile neonates, including whether febrile neonates with respiratory syncytial virus are at increased risk for developing a serious bacterial infection and whether diagnostic testing and empiric antiviral therapy for herpes simplex virus should be part of the standard evaluation of febrile neonates. Although the discovery of inflammatory mediators that are elevated during the early stages of infection has the potential to improve diagnostic capabilities in this age group, there is enough evidence to support international guidelines recommending hospitalization and sepsis evaluations in febrile neonates.

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“…In an attempt to stratify infectious risk, prior studies [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] showed a lower +SBI rate in infants with versus those without documented viral infection. None specifically examined a large cohort of consecutively evaluated febrile infants 28 days or younger (ie, those at highest risk for +SBI) to document exact rates of +RSV infection.…”

mentioning

confidence: 99%

Meta-analysis to Determine Risk for Serious Bacterial Infection in Febrile Outpatient Neonates With RSV Infection

Bonadio

Huang

Nateson

et al. 2016

Pediatric Emergency Care

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Sepsis Workup in Febrile Infants 0–90 Days of Age With Respiratory Syncytial Virus Infection

Abstract: Considerable variability exists in the sepsis workup of febrile infants with suspected RSV infection at our site. Concomitant UTIs are common in febrile, RSV-infected infants.

Cited by 39 publications

References 21 publications

Risk Factors in Children Hospitalized With RSV Bronchiolitis Versus Non–RSV Bronchiolitis

Risk Factors in Children Hospitalized With RSV Bronchiolitis Versus Non–RSV Bronchiolitis

Neonatal Fever in the Term Infant: Evaluation and Management Strategies

Meta-analysis to Determine Risk for Serious Bacterial Infection in Febrile Outpatient Neonates With RSV Infection

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