1258. Probability of Serious Bacterial Infection (SBI) in 1 - 90 Day Old Febrile Infants with Laboratory Viral Testing Perform
Session: Oral Abstract Session: Respiratory Viral Infections in Children
Saturday, October 5, 2013: 11:00 AM
Room: The Moscone Center: 200-212
Background: Serious bacterial infection (SBI) is associated with fever in infants 1-90 days old. Infants with viral illness are less likely to have SBI.  Multiple viruses can cause similar clinical symptoms. There is little data on the risk of SBI for infants with specific laboratory-confirmed viral infections.

Objective: Determine the proportion of infants with SBI with negative vs. positive laboratory viral results.

Methods: Febrile infants evaluated in outpatient and hospital settings were identified using the Intermountain Healthcare enterprise data warehouse between 2004 and 2012. Infants who had viral testing performed were included if they also had SBI testing within 5 days of the viral test date. Viral testing included culture, DFA, and PCR. The proportion and odds ratio for viral results were calculated and compared for each virus.

Results: There were 15,993 episodes during the study period; 8,352 (52%) had at least one viral test performed; 3,303 (40%) positive. Rhinovirus was detected in 45% of infants tested and was detected more frequently than any other virus. 805 (9.6%) infants with viral testing had SBI (621/5049 (12.3%) viral neg vs 184/3303 (5.6%) viral pos, OR .44 (.36-.50) p <.001. Specific viral results are shown in the table.

Viral Tests

SBI Proportion (%)

 

Total

Pos (%)

Neg vs Pos Viral

OR (95% CI)

p value

Any Resp Virus

7809

2998 (38)

11.4

5.9

.49 (.41-.58)

<.001

     RSV

7804

922 (12)

10.0

3.7

.34 (.24-.49)

<.001

     Influenza A

7198

367 (5)

10.2

2.7

.25 (.13-.46)

<.001

     Influenza B

7190

82 (1)

9.9

8.5

.85 (.39-1.86)

0.7

     hMPV

7158

129 (2)

9.9

5.4

.52 (.24-1.11)

0.09

     Adenovirus

7158

88 (1)

9.9

6.8

.66 (.29-1.53)

0.3

     Parainfluenza 1

7157

142 (2)

10.0

2.8

.26 (.10-.71)

0.01

     Parainfluenza 2

7157

76 (1)

10.0

2.6

.24 (.06-1.0)

0.05

     Parainfluenza 3

7158

199 (3)

9.9

7.5

.74 (.43-1.26)

0.2

     Rhinovirus

2445

1091 (45)

14.7

9.0

.57 (.44-.74)

<.001

Enterovirus

2555

374 (15)

13.7

2.9

.19 (.10-.35)

<.001

Conclusion: Viral infections are common in febrile infants. The proportion with concomitant SBI varies by virus type. SBI occurs significantly less frequently (2.6%-3.7%) in infants with RSV, influenza A, enterovirus, parainfluenza 1 and 2 when compared with infants who test negative for these viruses (10%-13.7%). Nearly half of the infants tested had rhinovirus detected. Although infants who test positive for rhinovirus are less likely to have SBI than those who test negative, the proportion with SBI is 9% limiting clinical relevance.

E. Kent Korgenski, MS1, Jacob Wilkes, BS1, Carolyn Reynolds, MS, APRN2, Xiaoming Sheng, PhD3 and Carrie L. Byington, MD3, (1)Department of Pediatrics, Pediatric Clinical Program, University of Utah School of Medicine and Intermountain Healthcare, Salt Lake City, UT, (2)Intermountain Healthcare, Salt Lake City, UT, (3)Pediatrics, University of Utah, Salt Lake City, UT

Disclosures:

E. K. Korgenski, None

J. Wilkes, None

C. Reynolds, None

X. Sheng, None

C. L. Byington, BioFire Diagnostics: Collaborator and Grant Investigator, Grant recipient and Licensing agreement or royalty

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