Serious bacterial infections in febrile infants 1 to 90 days old with and without viral infections

Carrie L. Byington, F. Rene Enriquez, Charles Hoff, Richard Tuohy, E. William Taggart, David R. Hillyard, Karen C Carroll, John C. Christenson

Research output: Contribution to journalArticle

Abstract

Objective. The risk of serious bacterial infection (SBI) in febrile infants who are classified as low risk (LR) or high risk (HR) by the Rochester criteria has been established. LR infants average a 1.4% occurrence of SBI, whereas HR infants have an occurrence of 21%. The occurrence of SBI in Rochester LR or HR infants with confirmed viral infections is unknown. The objective of this study was to determine the occurrence of SBI in Rochester LR and HR infants with and without viral infections. Methods. All febrile infants who were 90 days or younger and evaluated at Primary Children's Medical Center between December 1996 and June 2002 were eligible. Infants were classified as Rochester LR or HR, and discharge diagnoses were collected. Viral testing for enteroviruses, respiratory viruses, rotavirus, and herpesvirus was performed as indicated by study protocol, clinical presentation, and season of the year. Results of all bacterial cultures were reviewed. Results. Of 1779 infants enrolled, 1385 (78%) had some form of viral diagnostic testing and 491 (35%) had 1 or more viruses identified. By the Rochester criteria, 456 (33%) infants were classified as LR and 922 (67%) infants as HR. For infants with viral infections, the occurrence of SBI was significantly lower than in infants without a viral infection (4.2% vs 12.3%). Rochester HR virus-positive (HR+) infants had significantly fewer bacterial infections than HR virus-negative (HR-) infants (5.5% vs 16.7%). When compared with HR- infants, HR+ infants were less likely to have bacteremia, urinary tract infection, or soft tissue infections, and HR+ infants had a similar occurrence of bacteremia as LR infants (0.92% vs 1.97%). Conclusions. Febrile infants with confirmed viral infections are at lower risk for SBI than those in whom a viral infection is not identified. Viral diagnostic data can positively contribute to the management of febrile infants, especially those who are classified as HR.

Original languageEnglish (US)
Pages (from-to)1662-1666
Number of pages5
JournalPediatrics
Volume113
Issue number6 I
DOIs
StatePublished - Jun 2004

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Virus Diseases
Bacterial Infections
Fever
Viruses
Bacteremia
Soft Tissue Infections

Keywords

  • Bacterial infection
  • Febrile infant
  • Rochester criteria
  • Viral infection

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Byington, C. L., Enriquez, F. R., Hoff, C., Tuohy, R., Taggart, E. W., Hillyard, D. R., ... Christenson, J. C. (2004). Serious bacterial infections in febrile infants 1 to 90 days old with and without viral infections. Pediatrics, 113(6 I), 1662-1666. https://doi.org/10.1542/peds.113.6.1662

Serious bacterial infections in febrile infants 1 to 90 days old with and without viral infections. / Byington, Carrie L.; Enriquez, F. Rene; Hoff, Charles; Tuohy, Richard; Taggart, E. William; Hillyard, David R.; Carroll, Karen C; Christenson, John C.

In: Pediatrics, Vol. 113, No. 6 I, 06.2004, p. 1662-1666.

Research output: Contribution to journalArticle

Byington, CL, Enriquez, FR, Hoff, C, Tuohy, R, Taggart, EW, Hillyard, DR, Carroll, KC & Christenson, JC 2004, 'Serious bacterial infections in febrile infants 1 to 90 days old with and without viral infections', Pediatrics, vol. 113, no. 6 I, pp. 1662-1666. https://doi.org/10.1542/peds.113.6.1662
Byington CL, Enriquez FR, Hoff C, Tuohy R, Taggart EW, Hillyard DR et al. Serious bacterial infections in febrile infants 1 to 90 days old with and without viral infections. Pediatrics. 2004 Jun;113(6 I):1662-1666. https://doi.org/10.1542/peds.113.6.1662
Byington, Carrie L. ; Enriquez, F. Rene ; Hoff, Charles ; Tuohy, Richard ; Taggart, E. William ; Hillyard, David R. ; Carroll, Karen C ; Christenson, John C. / Serious bacterial infections in febrile infants 1 to 90 days old with and without viral infections. In: Pediatrics. 2004 ; Vol. 113, No. 6 I. pp. 1662-1666.
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abstract = "Objective. The risk of serious bacterial infection (SBI) in febrile infants who are classified as low risk (LR) or high risk (HR) by the Rochester criteria has been established. LR infants average a 1.4{\%} occurrence of SBI, whereas HR infants have an occurrence of 21{\%}. The occurrence of SBI in Rochester LR or HR infants with confirmed viral infections is unknown. The objective of this study was to determine the occurrence of SBI in Rochester LR and HR infants with and without viral infections. Methods. All febrile infants who were 90 days or younger and evaluated at Primary Children's Medical Center between December 1996 and June 2002 were eligible. Infants were classified as Rochester LR or HR, and discharge diagnoses were collected. Viral testing for enteroviruses, respiratory viruses, rotavirus, and herpesvirus was performed as indicated by study protocol, clinical presentation, and season of the year. Results of all bacterial cultures were reviewed. Results. Of 1779 infants enrolled, 1385 (78{\%}) had some form of viral diagnostic testing and 491 (35{\%}) had 1 or more viruses identified. By the Rochester criteria, 456 (33{\%}) infants were classified as LR and 922 (67{\%}) infants as HR. For infants with viral infections, the occurrence of SBI was significantly lower than in infants without a viral infection (4.2{\%} vs 12.3{\%}). Rochester HR virus-positive (HR+) infants had significantly fewer bacterial infections than HR virus-negative (HR-) infants (5.5{\%} vs 16.7{\%}). When compared with HR- infants, HR+ infants were less likely to have bacteremia, urinary tract infection, or soft tissue infections, and HR+ infants had a similar occurrence of bacteremia as LR infants (0.92{\%} vs 1.97{\%}). Conclusions. Febrile infants with confirmed viral infections are at lower risk for SBI than those in whom a viral infection is not identified. Viral diagnostic data can positively contribute to the management of febrile infants, especially those who are classified as HR.",
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AU - Byington, Carrie L.

AU - Enriquez, F. Rene

AU - Hoff, Charles

AU - Tuohy, Richard

AU - Taggart, E. William

AU - Hillyard, David R.

AU - Carroll, Karen C

AU - Christenson, John C.

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N2 - Objective. The risk of serious bacterial infection (SBI) in febrile infants who are classified as low risk (LR) or high risk (HR) by the Rochester criteria has been established. LR infants average a 1.4% occurrence of SBI, whereas HR infants have an occurrence of 21%. The occurrence of SBI in Rochester LR or HR infants with confirmed viral infections is unknown. The objective of this study was to determine the occurrence of SBI in Rochester LR and HR infants with and without viral infections. Methods. All febrile infants who were 90 days or younger and evaluated at Primary Children's Medical Center between December 1996 and June 2002 were eligible. Infants were classified as Rochester LR or HR, and discharge diagnoses were collected. Viral testing for enteroviruses, respiratory viruses, rotavirus, and herpesvirus was performed as indicated by study protocol, clinical presentation, and season of the year. Results of all bacterial cultures were reviewed. Results. Of 1779 infants enrolled, 1385 (78%) had some form of viral diagnostic testing and 491 (35%) had 1 or more viruses identified. By the Rochester criteria, 456 (33%) infants were classified as LR and 922 (67%) infants as HR. For infants with viral infections, the occurrence of SBI was significantly lower than in infants without a viral infection (4.2% vs 12.3%). Rochester HR virus-positive (HR+) infants had significantly fewer bacterial infections than HR virus-negative (HR-) infants (5.5% vs 16.7%). When compared with HR- infants, HR+ infants were less likely to have bacteremia, urinary tract infection, or soft tissue infections, and HR+ infants had a similar occurrence of bacteremia as LR infants (0.92% vs 1.97%). Conclusions. Febrile infants with confirmed viral infections are at lower risk for SBI than those in whom a viral infection is not identified. Viral diagnostic data can positively contribute to the management of febrile infants, especially those who are classified as HR.

AB - Objective. The risk of serious bacterial infection (SBI) in febrile infants who are classified as low risk (LR) or high risk (HR) by the Rochester criteria has been established. LR infants average a 1.4% occurrence of SBI, whereas HR infants have an occurrence of 21%. The occurrence of SBI in Rochester LR or HR infants with confirmed viral infections is unknown. The objective of this study was to determine the occurrence of SBI in Rochester LR and HR infants with and without viral infections. Methods. All febrile infants who were 90 days or younger and evaluated at Primary Children's Medical Center between December 1996 and June 2002 were eligible. Infants were classified as Rochester LR or HR, and discharge diagnoses were collected. Viral testing for enteroviruses, respiratory viruses, rotavirus, and herpesvirus was performed as indicated by study protocol, clinical presentation, and season of the year. Results of all bacterial cultures were reviewed. Results. Of 1779 infants enrolled, 1385 (78%) had some form of viral diagnostic testing and 491 (35%) had 1 or more viruses identified. By the Rochester criteria, 456 (33%) infants were classified as LR and 922 (67%) infants as HR. For infants with viral infections, the occurrence of SBI was significantly lower than in infants without a viral infection (4.2% vs 12.3%). Rochester HR virus-positive (HR+) infants had significantly fewer bacterial infections than HR virus-negative (HR-) infants (5.5% vs 16.7%). When compared with HR- infants, HR+ infants were less likely to have bacteremia, urinary tract infection, or soft tissue infections, and HR+ infants had a similar occurrence of bacteremia as LR infants (0.92% vs 1.97%). Conclusions. Febrile infants with confirmed viral infections are at lower risk for SBI than those in whom a viral infection is not identified. Viral diagnostic data can positively contribute to the management of febrile infants, especially those who are classified as HR.

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KW - Rochester criteria

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