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PEDIATRICS Vol. 113 No. 6 June 2004, pp. 1662-1666

Serious Bacterial Infections in Febrile Infants 1 to 90 Days Old With and Without Viral Infections

Carrie L. Byington, MD*, F. Rene Enriquez, BS{ddagger}, Charles Hoff, PhD*, Richard Tuohy, MIBS*, E. William Taggart, BS§, David R. Hillyard, MD§, Karen C. Carroll, MD§ and John C. Christenson, MD*

* Department of Pediatrics, University of Utah, Salt Lake City, Utah
{ddagger} General Clinical Research Center, University of Utah, Salt Lake City, Utah
§ Associated and Regional University Pathologists, Salt Lake City, Utah

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.

Key Words: febrile infant • viral infection • bacterial infection • Rochestercriteria

Abbreviations: SBI, serious bacterial infection • LR, Rochester low risk • HR, Rochester high risk • RSV, respiratory syncytial virus • EV, enteroviral • PCMC, Primary Children’s Medical Center • CSF, cerebrospinal fluid • PCR, polymerase chain reaction • UTI, urinary tract infection • HR+, high-risk virus positive • HR–, high-risk virus negative • LR+, low risk virus positive • LR–, low risk virus negative

Received for publication Jul 30, 2003; Accepted Nov 5, 2003.


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