Rapid Influenza Test in Young Febrile Infants for the Identification of Low-Risk Patients

Abstract

We included 381 febrile infants less than 3 months with a blood culture and a rapid influenza test done as part of study of fever. The prevalence of serious bacterial infections was significantly lower in patients in the positive rapid influenza test (RIT) group (3/113; 2.65%; 95% CI: 0-5.6) than in patients in the negative RIT group (47/268; 17.5%; 95% CI: 13-22.0). No patient with a positive RIT had a positive blood culture (vs. 8 in the negative RIT group, 2.98%, 95% CI: 0.9-5.0) The cerebrospinal fluid culture was positive in 5; all of them had a negative RIT. The use of RIT in the Emergency Department on previously well-appearing febrile young infants without a known source during influenza seasons can help to identify infants with a lower risk of developing serious bacterial infections. Routine blood culture may be no longer necessary in infants with a positive RIT.

Utility of early influenza diagnosis through point‐of‐care testing in children presenting to an emergency department

“…Our findings support previous studies, which found low rates of concurrent SBI in young children with influenza . These studies used POCT to diagnose influenza and documented a rate of SBI of 1.8% in influenza‐positive children aged 0–36 months and rates of 2.5–2.65% for children <3 months of age .…”

Influenza A infection in young infants

“…Based on the fairly mild course of influenza A in infants and studies showing significantly reduced serious bacterial infections in infants ≥28 days, it has been argued that the management of young infants with influenza infections should be changed in terms of performing less extensive laboratory and radiological studies 5. While our study is supportive of the fact that influenza infections are relatively mild in young infants, over 10% of the infants in our study had a coexisting serious bacterial infection.…”

Supporting decisions to increase the safe discharge of children with febrile illness from the emergency department: a systematic review and meta-analysis

“…In multivariable analysis a positive viral identification reduced the likelihood of SBI in young infants with febrile illness. A number of prospective studies corroborated this finding in young infants with respiratory syncytial virus48 and influenza,49 50 though the presence of virus alone was insufficient to rule out SBI. The impact of respiratory viral testing was summarised in a Cochrane review of randomised controlled trials including more than 1500 children.…”