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Observational Study
. 2018 Feb;141(2):e20172384.
doi: 10.1542/peds.2017-2384. Epub 2018 Jan 17.

Rhinovirus in Febrile Infants and Risk of Bacterial Infection

Anne J Blaschke  1 , E Kent Korgenski  2   3 , Jacob Wilkes  3 , Angela P Presson  4 , Emily A Thorell  2   3 , Andrew T Pavia  2 , Elizabeth D Knackstedt  2 , Carolyn Reynolds  3 , Jeff E Schunk  2 , Judy A Daly  5   6 , Carrie L Byington  2   7
Affiliations
Observational Study

Rhinovirus in Febrile Infants and Risk of Bacterial Infection

Anne J Blaschke et al. Pediatrics. 2018 Feb.

Abstract

Background: Febrile infants with viral respiratory infections have a reduced risk of bacterial infection compared with virus-negative infants. The risk of concomitant bacterial infection in febrile infants positive for human rhinovirus (HRV) by polymerase chain reaction (PCR) is unknown.

Methods: Infants 1-90 days old managed using the care process model for well-appearing febrile infants and with respiratory viral testing by PCR (RVPCR) in the emergency department or inpatient setting of 22 hospitals in the Intermountain Healthcare system from 2007-2016 were identified. Relative risk (RR) of bacterial infection was calculated for infants with HRV, non-HRV viruses, or no virus detected.

Results: Of 10 964 febrile infants identified, 4037 (37%) had RVPCR. Of these, 2212 (55%) were positive for a respiratory virus; 1392 (35%) for HRV alone. Bacterial infection was identified in 9.5%. Febrile infants with HRV detected were more likely to have bacterial infection than those with non-HRV viruses (7.8% vs 3.7%; P < .001; RR 2.12 [95% CI 1.43-3.15]). Risk of urinary tract infection was not significantly different for HRV-positive infants at any age, nor was risk of invasive bacterial infection (IBI; bacteremia and/or meningitis) meaningfully different for infants 1-28 day olds. Infants 29-90 days old with HRV had a decreased likelihood of IBI (RR 0.52 [95% CI 0.34-0.80]).

Conclusions: HRV is common in febrile infants. Detection did not alter risk of concomitant urinary tract infection at any age or risk of IBI in infants 1-28 days old. HRV detection may be relevant in considering risk of IBI for infants 29-90 days of age.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Drs Blaschke and Byington have intellectual property and receive royalties from BioFire Diagnostics LLC through the University of Utah; the other authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Frequency of bacterial infection by age and viral detection. Results are shown for all infants 1 to 90 days old and separately for infants 1 to 28 days old and 29 to 90 days old. The absolute frequency of infection in our cohort is indicated for each group, with the 95% CIs shown. A vertical line is drawn at a frequency of 10% as a reference.
See this image and copyright information in PMC

References

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