Positive Viral Tests in Febrile Young Infants: Do They Matter?

Abstract

Research Article| March 01 2019 Positive Viral Tests in Febrile Young Infants: Do They Matter? AAP Grand Rounds (2019) 41 (3): 30. https://doi.org/10.1542/gr.41-3-30 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Positive Viral Tests in Febrile Young Infants: Do They Matter?. AAP Grand Rounds March 2019; 41 (3): 30. https://doi.org/10.1542/gr.41-3-30 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: fever, bacterial infection, serious Source: Mahajan P, Browne LR, Levine DA, et al. Risk of bacterial coinfections in febrile infants 60 days old and younger with documented viral infections. J Pediatr. 2018; 203: 86.e2– 91.e2. doi: https://doi.org/10.1016/j.jpeds.2018.07.073Google Scholar Investigators from multiple institutions conducted a secondary analysis of data collected during a large prospective study in febrile infants ≤60 days old to assess the risk of serious bacterial infection (SBI) in patients with a documented viral infection. The original study was conducted by the Pediatric Emergency Care Applied Research Network and included children ≤60 days old, with a temperature >38.0°C, presenting to 1 of 26 EDs. Demographic information, physical examination findings, and laboratory results were collected for enrolled patients. For the current analysis, only study participants who were tested for at least one virus were included. The primary study outcome was the presence of an SBI, including UTI, bacteremia, or bacterial meningitis. The diagnosis of SBI was based on blood, urine, and cerebrospinal fluid culture results. For study patients in whom lumbar puncture was not performed, the absence of bacterial meningitis was confirmed based on telephone contact with the infants’ parents 7 days after the index visit. The rates of any SBI and each individual SBI were compared among viral-positive and viral-negative infants and the risk ratio (RR) calculated; analyses limited to children ≤28 days old and >28 days old were also conducted. Among the 4,788 infants enrolled in the original study, 3,072 (64.3%) had testing for at least one virus. Among these 3,072 infants, 2,945 (95.9%) who also had complete ascertainment for the presence of an SBI were included in the current analyses, of whom 1,200 (48.1%) had a positive test for ≥1 virus. The rate of SBI in viral-positive infants was 3.7% (95% CI, 2.7%–4.9%) compared to 12.7% (95% CI, 11.2%–14.4%) for those who were virus-negative (RR, 3.5; 95% CI, 2.5–4.8). Rates of UTI (2.8% and 10.7%, respectively) and bacteremia (0.8% and 2.9%, respectively) were also significantly lower in viral-positive infants than in viral-negative infants. Bacterial meningitis was diagnosed in 0.4% of viral-positive infants compared to 0.8% in viral-negative infants (RR, 1.9; 95% CI, 0.7%–5.3%). Among infants who were ≤28 days old and those who were >28 days old, the risk of SBI was significantly lower in viral-positive infants (RR, 4.0; 95% CI, 2.4–6.6 and RR, 2.9; 95% CI, 1.9–4.3, respectively). The authors conclude that, although the rate of SBI is lower in febrile infants ≤60 days old who have a documented viral infection than in those who are viral negative, viral-positive infants are still at nonnegligible risk for SBI. Dr Stevenson has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Substantial variation in the evaluation of the young febrile infant exists across pediatric EDs in the United States at both the patient and hospital levels.1 In the present study, viral testing via rapid antigen testing, immunofluorescence,... You do not currently have access to this content.