Utility of sepsis evaluation in infants 90 days of age or younger with fever and clinical bronchiolitis

Abstract

Objective: To identify the clinical utility of obtaining blood, urine and cerebrospinal fluid for bacterial culture among febrile infants <90 days of age with clinical bronchiolitis.

Design: Retrospective chart review from 1995 to 2000.

Setting: Urban emergency department of a tertiary children's hospital.

Participants: All infants <90 days of age presenting with fever and clinical bronchiolitis.

Main outcome measures: Result of the cultures of blood, urine and cerebrospinal fluid.

Results: Of 3051 (11%) febrile infants, 329 met criteria for clinical bronchiolitis. Blood for culture was obtained from 309 (94%), urine for culture was obtained from 273 (83%) and cerebrospinal fluid for culture was obtained from 200 (61%). One hundred eighty-seven (57%) infants had all 3 specimens sent for culture. No cases of bacteremia [0%; 95% confidence interval (CI), 0, 1.1%] or meningitis (0%; 95% CI 0, 1.8%) occurred among these infants. However, 6 infants (2%; 95% CI 0.8, 5.7%), all male, had a culture of urine consistent with infection (4 Escherichia coli, 1 Staphylococcus aureus, 1 viridans streptococci).

Conclusion: The risk of bacteremia or meningitis among infants <90 days with fever and bronchiolitis is low in this age group. The risk of urinary tract infection in this age group is also low, but not negligible, at 2%.