Risk of Bacterial Coinfections in Febrile Infants 60 Days Old and Younger with Documented Viral Infections.
Risk of Bacterial Coinfections in Febrile Infants 60 Days Old and Younger with Documented Viral Infections.
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在60天及以下的高热婴儿中细菌共感染的风险，病毒感染有记录。
DOI：
10.1016/j.jpeds.2018.07.073
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发表时间：
2018-12
期刊：
影响因子：
--
通讯作者：
Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN)
中科院分区：
文献类型：
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作者：
Mahajan P;Browne LR;Levine DA;Cohen DM;Gattu R;Linakis JG;Anders J;Borgialli D;Vitale M;Dayan PS;Casper TC;Ramilo O;Kuppermann N;Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN)
确定有和无病毒感染的发热幼儿发生严重细菌感染（SBI）的风险。计划对一项前瞻性观察性研究进行次要分析，研究对象为在26个急诊科中的1个进行评价的60天或更小的发热婴儿，这些婴儿没有临床败血症或可识别的细菌感染部位。我们比较了病毒阳性和病毒阴性婴儿的患者人口统计学资料、临床和实验室检查结果以及SBI的患病率。在入组的4778名婴儿中，2945名（61.6%）进行了病毒检测，其中1200名（48.1%）为病毒阳性; 1200名婴儿中有44名患有SBI（3.7%; 95% CI，2.7%-4.9%）。在1745名病毒阴性婴儿中，222名患有SBI（12.7%; 95%CI，11.2%-14.4%）。病毒阳性组与病毒阴性组的特异性SBI发生率分别为：（33/1200 [2.8%; 95% CI，1.9%-3.8%] vs 186/1745 [10.7%; 95% CI，9.2%-12.2%]）和菌血症（9/1199 [0.8%; 95% CI，0.3%-1.4%] vs 50/1743 [2.9%; 95% CI，2.1%-3.8%]）。病毒阳性组的细菌性脑膜炎发生率（0.4%）低于病毒阴性组（0.8%），差异无统计学意义。在多变量分析中，阴性病毒状态（aOR，3.2; 95%CI，2.3-4.6）与SBI显著相关。≤60天的发热婴儿病毒感染的SBI风险显著较低，但不可忽略，包括菌血症和细菌性脑膜炎。
To determine the risk of serious bacterial infections (SBIs) in young febrile infants with and without viral infections. Planned secondary analyses of a prospective observational study of febrile infants 60 days of age or younger evaluated at 1 of 26 emergency departments who did not have clinical sepsis or an identifiable site of bacterial infection. We compared patient demographics, clinical, and laboratory findings, and prevalence of SBIs between virus-positive and virus-negative infants. Of the 4778 enrolled infants, 2945 (61.6%) had viral testing performed, of whom 1200 (48.1%) were virus positive; 44 of the 1200 had SBIs (3.7%; 95% CI, 2.7%-4.9%). Of the 1745 virus-negative infants, 222 had SBIs (12.7%; 95% CI, 11.2%-14.4%). Rates of specific SBIs in the virus-positive group vs the virus-negative group were: UTIs (33 of 1200 [2.8%; 95% CI, 1.9%-3.8%] vs 186 of 1745 [10.7%; 95% CI, 9.2%-12.2%]) and bacteremia (9 of 1199 [0.8%; 95% CI, 0.3%-1.4%] vs 50 of 1743 [2.9%; 95% CI, 2.1%-3.8%]). The rate of bacterial meningitis tended to be lower in the virus-positive group (0.4%) than in the viral-negative group (0.8%); the difference was not statistically significant. Negative viral status (aOR, 3.2; 95% CI, 2.3-4.6), was significantly associated with SBI in multivariable analysis. Febrile infants ≤60 days of age with viral infections are at significantly lower, but non-negligible risk for SBIs, including bacteremia and bacterial meningitis.
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