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

J Pediatr. 2018 Dec;203:86-91.e2. doi: 10.1016/j.jpeds.2018.07.073. Epub 2018 Sep 6.

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.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Bacteremia / epidemiology*
  • Coinfection / epidemiology*
  • Emergency Service, Hospital
  • Female
  • Fever / etiology*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Meningitis, Bacterial / epidemiology*
  • Prospective Studies
  • Risk Assessment
  • Sampling Studies
  • Urinary Tract Infections / epidemiology*
  • Virus Diseases / epidemiology*