Meta-analysis to Determine Risk for Serious Bacterial Infection in Febrile Outpatient Neonates With RSV Infection
Meta-analysis to Determine Risk for Serious Bacterial Infection in Febrile Outpatient Neonates With RSV Infection
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DOI：
10.1097/pec.0000000000000799
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发表时间：
2016-05-01
影响因子：
1.4
通讯作者：
Homel, Peter
中科院分区：
文献类型：
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作者：
Bonadio, William;Huang, Felix;Homel, Peter
目的：本研究旨在分析一大组28天或更小的发热新生儿，这些新生儿接受了门诊脓毒症评估和呼吸道合胞病毒（RSV）感染的鼻咽抽吸物抗原检测（NPAT），以确定病毒研究结果与严重细菌感染风险之间是否存在临床显著相关性（SBI：细菌性脑膜炎、菌血症、尿路感染、细菌性肠炎）。我们评估了在我们城市儿科急诊科就诊的28天或更小的连续发热新生儿[迈蒙尼德医学中心（MMC）]在6年期间，所有患者均接受了脓毒症评估（脑脊液、血液、尿培养）和RSV NPAT。为了达到足够的权力（80%），MMC数据相结合，从以前的前瞻性PEM-CRC研究类似的年龄发热新生儿谁收到类似evaluation.Results：从MMC数据连续评估的情况下，患病率+ RSV在387发热新生儿为6%。其中，378例（98%）患者接受了脓毒症评价和RSV NPAT; + RSV患者中4/22例（18.1%）发生+ SBI，而-RSV患者中58/356例（16.2%）发生+SBI（P = 0.77）。结合411例接受类似评价的28天或更小的发热新生儿的PEM-CRC队列，共789例病例使用荟萃分析进行分析。总体而言，有117例（14.8%）+ SBI病例和104例（13.2%）+ RSV病例。RSV阳性组SBI阳性率为11.5%，RSV阴性组SBI阳性率为15.3%。荟萃分析显示，感染和未感染+ RSV的新生儿之间+ SBI的发生率无显著差异（比值比，0.78; 95%置信区间，0.41-1.50; P = 0.46）。结论：感染和未感染+ RSV的28天或以下发热新生儿之间+ SBI的发生率无显著差异。呼吸道病毒感染状态不是区分发热新生儿SBI风险的准确临床决定因素。
Objectives: This study aimed to analyze a large group of febrile neonates 28 days or younger who received outpatient sepsis evaluation and nasopharyngeal aspirate antigen testing (NPAT) for respiratory syncytial viral (RSV) infection to determine whether there is a clinically significant association between viral study results and risk for serious bacterial infection (SBI: bacterial meningitis, bacteremia, urinary tract infection, bacterial enteritis).Methods: We evaluated consecutive febrile neonates 28 days or younger presenting to our urban pediatric emergency department [Maimonides Medical Center (MMC)] during a 6-year period, all of whom received a sepsis evaluation (cerebrospinal fluid, blood, urine cultures) and RSV NPAT. To achieve adequate power (80%), the MMC data were combined with similar data reported from a prior prospective PEM-CRC study of like-aged febrile neonates who received similar evaluation.Results: From the MMC data of consecutively evaluated cases, the prevalence rate of + RSV in 387 febrile neonates was 6%. Of these, 378 (98%) received both a sepsis evaluation and RSV NPAT; + SBI occurred in 4/22 (18.1%) with + RSV versus 58/356 (16.2%) with -RSV (P = 0.77). Combined with the PEM-CRC cohort of 411 febrile neonates 28 days or younger who received similar evaluation, a total of 789 cases were analyzed using meta-analysis. Overall, there were 117 (14.8%) cases of + SBI and 104 (13.2%) cases of + RSV. The rate of + SBI was 11.5% in those with + RSV versus 15.3% in those with -RSV. Meta-analysis performed showed no significant difference in rates of + SBI between those with and without + RSV (odds ratio, 0.78; 95% confidence interval, 0.41-1.50; P = 0.46).Conclusions: Rates of + SBI are not significantly different between febrile neonates 28 days or younger with and without + RSV. Respiratory viral infection status is not an accurate clinical determinant in distinguishing SBI risk in febrile neonates.