Risk of Bacterial Coinfections in Febrile Infants 60 Days Old and Younger with Documented Viral Infections

Casper, T. Charles; Ramilo, Octavio; Powell, Elizabeth C.; Levine, Deborah A.; Tunik, Michael G.; Nigrovic, Lise E.; Roosevelt, Genie; Mahajan, Prashant; Vitale, Melissa; Browne, Lorin R.; Saunders, Mary; Atabaki, Shireen M.; Ruddy, Richard M.; Linakis, James G.; Hoyle, John D.; Borgialli, Dominic; Blumberg, Stephen; Crain, Ellen F.; Anders, Jennifer; Bonsu, Bema K.; Cohen, Daniel M.; Bennett, Jonathan E.; Dayan, Peter; Greenberg, Richard A.; Jaffe, David M.; Muenzer, Jared T.; Cruz, Andrea T.; Macias, Charles G.; Kuppermann, Nathan; Tzimenatos, Leah; Gattu, Rajender; Rogers, Alexander; Brayer, Anne; Lillis, Kathleen

doi:10.1016/j.jpeds.2018.07.073

Cited by 54 publications

(58 citation statements)

References 30 publications

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“…Febrile urinary tract infection (UTI) is the most common serious bacterial infection in children [1][2][3]. Febrile UTI can occur simultaneously with a respiratory tract infection, but the likelihood of UTI has been reported to be significantly lower among respiratory virus-positive than in virus-negative febrile infants [4,5]. Highly sensitive multiplex polymerase chain reaction (PCR) assays and other nucleic acid amplification tests with short turnaround times are currently widely used in hospitals and emergency departments (EDs) for detecting respiratory viruses.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of respiratory viruses and antiviral MxA responses in children with febrile urinary tract infection

Piri

Ivaska

Yahya

et al. 2020

Eur J Clin Microbiol Infect Dis

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Blood myxovirus resistance protein A (MxA) has broad antiviral activity, and it is a potential biomarker for symptomatic virus infections. Limited data is available of MxA in coinciding viral and bacterial infections. We investigated blood MxA levels in children hospitalized with a febrile urinary tract infection (UTI) with or without simultaneous respiratory virus infection. We conducted a prospective observational study of 43 children hospitalized with febrile UTI. Nasopharyngeal swab samples were collected at admission and tested for 16 respiratory viruses by nucleic acid detection methods. Respiratory symptoms were recorded, and blood MxA levels were determined. The median age of study children was 4 months (interquartile range, 2-14 months). A respiratory virus was detected in 17 (40%) children with febrile UTI. Of the virus-positive children with febrile UTI, 7 (41%) had simultaneous respiratory symptoms. Blood MxA levels were higher in virus-positive children with respiratory symptoms (median, 778 [interquartile range, 535-2538] μg/L) compared to either virus-negative (155 [94-301] μg/L, P < 0.001) or virus-positive (171 [112-331] μg/L, P = 0.006) children without respiratory symptoms at presentation with febrile UTI. MxA differentiated virus-positive children with respiratory symptoms from virus-negative without symptoms by an area under the receiver operating characteristic curve of 0.96. Respiratory viruses were frequently detected in children with febrile UTI. In UTI with simultaneous respiratory symptoms, host antiviral immune response was demonstrated by elevated blood MxA protein levels. MxA protein could be a robust biomarker of symptomatic viral infection in children with febrile UTI.

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Section: Introductionmentioning

confidence: 99%

Prevalence of respiratory viruses and antiviral MxA responses in children with febrile urinary tract infection

Piri

Ivaska

Yahya

et al. 2020

Eur J Clin Microbiol Infect Dis

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“…Uncontaminated urine specimens collected from infants are of particular importance given their high rates of UTI even when well appearing and with documented viral infections . Attempts to optimise CCU collection in infants have been evaluated previously.…”

Section: Discussionmentioning

confidence: 99%

Educational intervention does not reduce non‐invasive urine contamination rates in children presenting to the emergency department

Jacob

John‐Denny

Donaldson

et al. 2019

J Paediatrics Child Health

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Aim: Urinary tract infection is common in children with high contamination rates with non-invasive urine sampling (NIU). Our aims were to evaluate an educational tool for decreasing contamination rates and find factors associated with contamination. Methods: This was a prospective cohort interventional study with a review of microbiology data and medical records of all NIU specimens collected at a large tertiary children's emergency department (ED) over a 1-year period. The intervention was the provision of a urine collection kit and educational pamphlet and education of staff. NIU contamination was calculated for 6 months pre-intervention and 6 months post-intervention. The association of factors with NIU contamination was evaluated for all cohorts (age, gender, presence of diarrhoea, season, time of day, time to incubation and activity of the ED). Results: A total of 2104 NIU samples were included (median age 3 years, 52% females). There was no difference between periods in contamination rates (29.2% and 31.2%, respectively, P = 0.322). Collectively, high monthly activity of the department, age and female gender were associated with contamination. The highest contamination rates were among children aged 0-3 months and 12 years and older (38.1 and 48.9%, respectively). Conclusions: The urine collection kit and educational tool did not decrease NIU contamination rates in our ED. Contamination rates were correlated with the monthly activity of our department and female gender and were noticeably high among infants and adolescents. Given the high prevalence of urinary tract infection among these age groups, measures should be taken to reassess indications and methods for urine collection.

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“…58% of febrile infants have viral infections and 15% have bacterial infections. Neonates less than 28 days of age with a viral infection remain at high risk for concomitant invasive bacterial illness [5,6]. Bundling should not be considered a cause of high RT 38°C when room temperature is less than 35 and humidity less than 75% [7].…”

Section: Causes Of Fever In Young Infantsmentioning

confidence: 99%

“…Clinical indicators of IBI in febrile infant [12,13,5 1-WBC: 15000 or less than 5000. 2-ABC (absolute band count) of 1500 or more.…”

Section: Febrile Infant Younger Than 3 Months Approachmentioning

confidence: 99%

Balanced Approach to Neonates and Young Infants with Fever

Alsaeed¹,

Alsaeed²,

Alsaeed³

2019

AJP

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Fever in early infancy may indicate the presence of an invasive bacterial infection [IBI]. Viral infection is the most common cause of fever in young infants, with Rhinovirus being the most common. Rectal temperature 38°C should be considered as fever. Bacterial infection may be the cause of fever in this age group even in the presence of a clear viral etiology. Evaluation and treatment of febrile infants during the first 3 months of life requires a balanced and cautious approach. After the introduction of vaccines in early infancy, there have been considerable changes in the bacterial pathogens and consecutive changes in the evaluation and empiric treatment of febrile young infants. While full septic screen seems necessary in the evaluation of many febrile young infants, partial septic screen without Lumbar puncture could be better in selected cases. It is the responsibility of the pediatrician to recognize the risk of invasive bacterial infection and to avoid unnecessary investigations at the same time. In this study, we suggest a simple approach that avoids the weak points of the available approach plans. Using clinical examples, we try to simplify this practical challenge.

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Risk of Bacterial Coinfections in Febrile Infants 60 Days Old and Younger with Documented Viral Infections

Abstract: Febrile infants ≤60 days of age with viral infections are at significantly lower, but non-negligible risk for SBIs, including bacteremia and bacterial meningitis.

Cited by 54 publications

References 30 publications

Prevalence of respiratory viruses and antiviral MxA responses in children with febrile urinary tract infection

Prevalence of respiratory viruses and antiviral MxA responses in children with febrile urinary tract infection

Educational intervention does not reduce non‐invasive urine contamination rates in children presenting to the emergency department

Balanced Approach to Neonates and Young Infants with Fever

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