Risk of serious bacterial infection in young febrile infants with respiratory syncytial virus infections
Risk of serious bacterial infection in young febrile infants with respiratory syncytial virus infections
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DOI：
10.1542/peds.113.6.1728
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发表时间：
2004-06-01
期刊：
影响因子：
8
通讯作者：
Kuppermann, N
中科院分区：
文献类型：
--
作者：
Levine, DA;Platt, SL;Kuppermann, N
背景对发热幼儿的评估是有争议的，部分原因是尚不清楚病毒感染的临床证据是否能显著降低严重细菌感染（SBI）的风险。具体来说，目前尚不清楚SBI的风险是否在呼吸道合胞病毒（RSV）感染的情况下以有意义的方式改变。本研究的目的是确定与未感染RSV的婴儿相比，感染RSV的发热婴儿发生SBI的风险。我们进行了一项为期3年的多中心、前瞻性、横断面研究。所有从1998年10月至2001年3月期间到8个儿科急诊科就诊的小于或等于60天的发热（大于或等于38 ℃）婴儿均符合入选标准。使用耶鲁观察量表评价一般临床表现。我们通过鼻咽分泌物的抗原检测来确定RSV状态。我们将毛细支气管炎定义为单独的喘息或与上呼吸道感染相关的胸部收缩。我们评估了婴儿的血液，尿液，脑脊液和粪便培养。尿路感染（UTI）定义为单个病原体生长大于或等于5 × 10（4）cfu/mL，或导管标本中>10（4）cfu/mL并伴有尿分析阳性，或耻骨上穿刺液中>10（3）cfu/mL。菌血症、细菌性脑膜炎和细菌性肠炎定义为已知细菌病原体的生长。SBI定义为上述4种细菌感染之一。我们招募了1248名患者，其中269名（22%）患有RSV感染。1248例患者中有1169例（94%）可确定总体SBI状态，SBI发生率为11.4%（133/1169; 95%置信区间[CI]：9.6%-13.3%）。RSV阳性婴儿的SBI率为7.0%（17/244; 95%CI：4.1%-10.9%），而RSV阴性婴儿的SBI率为12.5%（116/925; 95%CI：10.5%-14.8%）（风险差异：5.5%; 95%CI：1.7%-9.4%）。RSV阳性婴儿的UTI发生率为5.4%（14/261; 95%CI：3.0%-8.8%），而RSV阴性婴儿的UTI发生率为10.1%（98/966; 95%CI：8.3%-12.2%）（风险差异：4.7%; 95%CI：1.4%-8.1%）。RSV阳性婴儿的菌血症发生率低于RSV阴性婴儿（1.1% vs 2.3%;风险差异：1.2%; 95%CI：-0.4%至2.7%）。无RSV阳性婴儿发生细菌性脑膜炎（0/251; 95%CI：0%-1.2%）;然而，两组间菌血症和细菌性脑膜炎的差异无统计学意义。小于或等于60日龄且有RSV感染的发热婴儿发生SBI的风险显著低于无RSV感染的发热婴儿。尽管如此，在发热RSV阳性婴儿中，SBI的发生率，特别是UTI的发生率，仍然很高。
Background. The evaluation of young febrile infants is controversial, in part because it is unclear whether clinical evidence of a viral infection significantly reduces the risk of serious bacterial infections (SBIs). Specifically, it remains unclear whether the risk of SBI is altered in a meaningful way in the presence of respiratory syncytial virus (RSV) infections.Objective. The objective of this study was to determine the risk of SBI in young febrile infants who are infected with RSV compared with those without RSV infections.Methods. We conducted a 3-year multicenter, prospective, cross-sectional study. All febrile (greater than or equal to38degreesC) infants who were less than or equal to60 days of age and presented to any of 8 pediatric emergency departments from October through March 1998-2001 were eligible. General clinical appearance was evaluated using the Yale Observational Scale. We determined RSV status by antigen testing of nasopharyngeal secretions. We defined bronchiolitis as either wheezing alone or chest retractions in association with an upper respiratory infection. We evaluated infants with blood, urine, cerebrospinal fluid, and stool cultures. Urinary tract infection (UTI) was defined by single pathogen growth of greater than or equal to5x10(4) cfu/mL, or >10(4) cfu/mL in association with a positive urinalysis in a catheterized specimen, or >10(3) cfu/mL in a suprapubic aspirate. Bacteremia, bacterial meningitis, and bacterial enteritis were defined by growth of a known bacterial pathogen. SBI was defined as any of the above-mentioned 4 bacterial infections.Results. We enrolled 1248 patients, including 269 (22%) with RSV infections. The overall SBI status could be determined in 1169 (94%) of the 1248 patients, and the rate of SBIs was 11.4% (133 of 1169; 95% confidence interval [CI]: 9.6%-13.3%). The rate of SBIs in the RSV-positive infants was 7.0% (17 of 244; 95% CI: 4.1%-10.9%) compared with 12.5% (116 of 925; 95% CI: 10.5%-14.8%) in the RSV-negative infants (risk difference: 5.5%; 95% CI: 1.7%-9.4%). The rate of UTI in the RSV-positive infants was 5.4% (14 of 261; 95% CI: 3.0%-8.8%) compared with 10.1% (98 of 966; 95% CI: 8.3%-12.2%) in the RSV-negative infants (risk difference: 4.7%; 95% CI: 1.4%-8.1%). The RSV-positive infants had a lower rate of bacteremia than the RSV-negative infants (1.1% vs 2.3%; risk difference: 1.2%; 95% CI: -0.4% to 2.7%). No RSV-positive infant had bacterial meningitis (0 of 251; 95% CI: 0%-1.2%); however, the differences between the 2 groups with regard to bacteremia and bacterial meningitis did not achieve statistical significance.Conclusions. Febrile infants who are less than or equal to60 days of age and have RSV infections are at significantly lower risk of SBI than febrile infants without RSV infection. Nevertheless, the rate of SBIs, particularly as a result of UTI, remains appreciable in febrile RSV-positive infants.