Published online June 29, 2009
PEDIATRICS Vol. 124 No. 1 July 2009, pp. 30-39 (doi:10.1542/peds.2008-2915)

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ARTICLE

Influenza Virus Infection and the Risk of Serious Bacterial Infections in Young Febrile Infants

William I. Krief, MD^a, Deborah A. Levine, MD^b, Shari L. Platt, MD^c,d, Charles G. Macias, MD, MPH^e, Peter S. Dayan, MD, MSc^c, Joseph J. Zorc, MD^f,g, Nancy Feffermann, MD^h, Nathan Kuppermann, MD, MPHⁱ for the Multicenter RSV-SBI Study Group of the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics

^a Departments of Pediatrics and Emergency Medicine, Long Island Jewish Hospital/Schneider Children's Hospital, New Hyde Park, New York
Departments of ^b Pediatrics and Emergency Medicine
^h Radiology, New York University School of Medicine/Bellevue Hospital Center, New York, New York
^c Departments of Pediatrics and Emergency Medicine, Children's Hospital of New York Presbyterian, New York, New York
^d Department of Emergency Medicine, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
^e Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
^f Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
^g Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
ⁱ Departments of Emergency Medicine and Pediatrics, University of California, Davis School of Medicine, Davis, California

OBJECTIVE: We aimed to determine the risk of SBIs in febrile infants with influenza virus infections and compare this risk with that of febrile infants without influenza infections.

PATIENTS AND METHODS: We conducted a multicenter, prospective, cross-sectional study during 3 consecutive influenza seasons. All febrile infants 60 days of age evaluated at any of 5 participating pediatric EDs between October and March of 1998 through 2001 were eligible. We determined influenza virus status by rapid antigen detection. We evaluated infants with blood, urine, cerebrospinal fluid, and stool cultures. Urinary tract infection (UTI) was defined by single-pathogen growth of either 5 x 10⁴ colony-forming units per mL or 10⁴ colony-forming units per mL in association with a positive urinalysis. Bacteremia, bacterial meningitis, and bacterial enteritis were defined by growth of a known bacterial pathogen. SBI was defined as any of the 4 above-mentioned bacterial infections.

RESULTS: During the 3-year study period, 1091 infants were enrolled. A total of 844 (77.4%) infants were tested for the influenza virus, of whom 123 (14.3%) tested positive. SBI status was determined in 809 (95.9%) of the 844 infants. Overall, 95 (11.7%) of the 809 infants tested for influenza virus had an SBI. Infants with influenza infections had a significantly lower prevalence of SBI (2.5%) and UTI (2.4%) when compared with infants who tested negative for the influenza virus. Although there were no cases of bacteremia, meningitis, or enteritis in the influenza-positive group, the differences between the 2 groups for these individual infections were not statistically significant.

CONCLUSIONS: Febrile infants 60 days of age with influenza infections are at significantly lower risk of SBIs than febrile infants who are influenza-negative. Nevertheless, the rate of UTI remains appreciable in febrile, influenza-positive infants.

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Key Words: fever • infants • influenza virus • serious bacterial infection • bacteremia • urinary tract infection • RSV • bronchiolitis

Abbreviations: SBI—serious bacterial infection • UTI—urinary tract infection • RSV—respiratory syncytial virus • ED—emergency department • CSF—cerebrospinal fluid • CXR—chest radiograph • WBC—white blood cell • RIA—rapid immunoassay • YOS—Yale Observation Scale • CI—confidence interval • RR—relative risk • CFU—colony-forming unit

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