Anne J Blaschke1, E Kent Korgenski2,3, Jacob Wilkes3, Angela P Presson4, Emily A Thorell2,3, Andrew T Pavia2, Elizabeth D Knackstedt2, Carolyn Reynolds3, Jeff E Schunk2, Judy A Daly5,6, Carrie L Byington2,7. 1. Departments of Pediatrics, anne.blaschke@hsc.utah.edu. 2. Departments of Pediatrics. 3. Pediatric Clinical Program, Intermountain Healthcare, Salt Lake City, Utah. 4. Internal Medicine, and. 5. Pathology, School of Medicine, University of Utah, Salt Lake City, Utah. 6. Patient Centered Microbiology Laboratory, Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, Utah; and. 7. College of Medicine, Texas A&M Health Sciences Center, Bryan, Texas.
Abstract
BACKGROUND: Febrile infants with viral respiratory infections have a reduced risk of bacterial infection compared with virus-negative infants. The risk of concomitant bacterial infection in febrile infants positive for human rhinovirus (HRV) by polymerase chain reaction (PCR) is unknown. METHODS: Infants 1-90 days old managed using the care process model for well-appearing febrile infants and with respiratory viral testing by PCR (RVPCR) in the emergency department or inpatient setting of 22 hospitals in the Intermountain Healthcare system from 2007-2016 were identified. Relative risk (RR) of bacterial infection was calculated for infants with HRV, non-HRV viruses, or no virus detected. RESULTS: Of 10 964 febrile infants identified, 4037 (37%) had RVPCR. Of these, 2212 (55%) were positive for a respiratory virus; 1392 (35%) for HRV alone. Bacterial infection was identified in 9.5%. Febrile infants with HRV detected were more likely to have bacterial infection than those with non-HRV viruses (7.8% vs 3.7%; P < .001; RR 2.12 [95% CI 1.43-3.15]). Risk of urinary tract infection was not significantly different for HRV-positive infants at any age, nor was risk of invasive bacterial infection (IBI; bacteremia and/or meningitis) meaningfully different for infants 1-28 day olds. Infants 29-90 days old with HRV had a decreased likelihood of IBI (RR 0.52 [95% CI 0.34-0.80]). CONCLUSIONS: HRV is common in febrile infants. Detection did not alter risk of concomitant urinary tract infection at any age or risk of IBI in infants 1-28 days old. HRV detection may be relevant in considering risk of IBI for infants 29-90 days of age.
BACKGROUND: Febrile infants with viral respiratory infections have a reduced risk of bacterial infection compared with virus-negative infants. The risk of concomitant bacterial infection in febrile infants positive for human rhinovirus (HRV) by polymerase chain reaction (PCR) is unknown. METHODS:Infants 1-90 days old managed using the care process model for well-appearing febrile infants and with respiratory viral testing by PCR (RVPCR) in the emergency department or inpatient setting of 22 hospitals in the Intermountain Healthcare system from 2007-2016 were identified. Relative risk (RR) of bacterial infection was calculated for infants with HRV, non-HRV viruses, or no virus detected. RESULTS: Of 10 964 febrile infants identified, 4037 (37%) had RVPCR. Of these, 2212 (55%) were positive for a respiratory virus; 1392 (35%) for HRV alone. Bacterial infection was identified in 9.5%. Febrile infants with HRV detected were more likely to have bacterial infection than those with non-HRV viruses (7.8% vs 3.7%; P < .001; RR 2.12 [95% CI 1.43-3.15]). Risk of urinary tract infection was not significantly different for HRV-positive infants at any age, nor was risk of invasive bacterial infection (IBI; bacteremia and/or meningitis) meaningfully different for infants 1-28 day olds. Infants 29-90 days old with HRV had a decreased likelihood of IBI (RR 0.52 [95% CI 0.34-0.80]). CONCLUSIONS:HRV is common in febrile infants. Detection did not alter risk of concomitant urinary tract infection at any age or risk of IBI in infants 1-28 days old. HRV detection may be relevant in considering risk of IBI for infants 29-90 days of age.
Authors: Kristine R Rittichier; Paul A Bryan; Kathlene E Bassett; E William Taggart; F Rene Enriquez; David R Hillyard; Carrie L Byington Journal: Pediatr Infect Dis J Date: 2005-06 Impact factor: 2.129
Authors: Tara L Greenhow; Yun-Yi Hung; Arnd M Herz; Elizabeth Losada; Robert H Pantell Journal: Pediatr Infect Dis J Date: 2014-06 Impact factor: 2.129
Authors: Carrie L Byington; F Rene Enriquez; Charles Hoff; Richard Tuohy; E William Taggart; David R Hillyard; Karen C Carroll; John C Christenson Journal: Pediatrics Date: 2004-06 Impact factor: 7.124
Authors: Mark A Poritz; Anne J Blaschke; Carrie L Byington; Lindsay Meyers; Kody Nilsson; David E Jones; Stephanie A Thatcher; Thomas Robbins; Beth Lingenfelter; Elizabeth Amiott; Amy Herbener; Judy Daly; Steven F Dobrowolski; David H-F Teng; Kirk M Ririe Journal: PLoS One Date: 2011-10-19 Impact factor: 3.240
Authors: Tasnee Chonmaitree; Pedro Alvarez-Fernandez; Kristofer Jennings; Rocio Trujillo; Tal Marom; Michael J Loeffelholz; Aaron L Miller; David P McCormick; Janak A Patel; Richard B Pyles Journal: Clin Infect Dis Date: 2014-09-09 Impact factor: 9.079
Authors: Prashant Mahajan; Lorin R Browne; Deborah A Levine; Daniel M Cohen; Rajender Gattu; James G Linakis; Jennifer Anders; Dominic Borgialli; Melissa Vitale; Peter S Dayan; T Charles Casper; Octavio Ramilo; Nathan Kuppermann Journal: J Pediatr Date: 2018-09-06 Impact factor: 4.406
Authors: Cinta Moraleda; Alfredo Tagarro; Daniel Blázquez-Gamero; Cristina Epalza; José Antonio Alonso Cadenas; Lourdes Calleja Gero; Cristina Calvo; Paula Rodríguez-Molino; María Méndez; Maria Del Mar Santos; Victoria Fumadó; María Fernanda Guzmán; Antoni Soriano-Arandes; Ana B Jiménez; Maria Penin; Elvira Cobo-Vazquez; Marta Pareja; Zulema Lobato; Miquel Serna; Rafael Delgado Journal: Eur J Pediatr Date: 2021-02-19 Impact factor: 3.860