Serious bacterial infections in febrile infants 1 to 90 days old with and without viral infections
Serious bacterial infections in febrile infants 1 to 90 days old with and without viral infections
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DOI：
10.1542/peds.113.6.1662
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发表时间：
2004-06-01
期刊：
影响因子：
8
通讯作者：
Christenson, JC
中科院分区：
文献类型：
--
作者：
Byington, CL;Enriquez, FR;Christenson, JC
Objective.根据罗切斯特标准分类为低风险（LR）或高风险（HR）的发热婴儿发生严重细菌感染（SBI）的风险已经确定。LR婴儿平均SBI发生率为1.4%，而HR婴儿的发生率为21%。在确诊病毒感染的罗切斯特LR或HR婴儿中SBI的发生率尚不清楚。本研究的目的是确定SBI的发生率在罗切斯特LR和HR婴儿有和没有病毒感染。1996年12月至2002年6月期间在初级儿童医学中心评估的90天或更小的所有发热婴儿都符合条件。将婴儿分类为罗切斯特LR或HR，并收集出院诊断。根据研究方案、临床表现和季节进行肠道病毒、呼吸道病毒、轮状病毒和疱疹病毒的病毒检测。结果在1779名入组的婴儿中，1385名（78%）进行了某种形式的病毒诊断检测，491名（35%）发现了1种或多种病毒。根据罗切斯特标准，456例（33%）婴儿被归类为LR，922例（67%）婴儿被归类为HR。对于病毒感染的婴儿，SBI的发生率显著低于无病毒感染的婴儿（4.2% vs 12.3%）。罗切斯特HR病毒阳性（HR+）婴儿的细菌感染显著少于HR病毒阴性（HR-）婴儿（5.5% vs 16.7%）。与HR-婴儿相比，HR+婴儿发生菌血症、尿路感染或软组织感染的可能性较小，HR+婴儿与LR婴儿的菌血症发生率相似（0.92% vs 1.97%）。确诊病毒感染的发热婴儿发生SBI的风险低于未确诊病毒感染的婴儿。病毒诊断数据可以积极促进发热婴儿的管理，特别是那些被归类为HR的婴儿。
Objective. The risk of serious bacterial infection (SBI) in febrile infants who are classified as low risk (LR) or high risk (HR) by the Rochester criteria has been established. LR infants average a 1.4% occurrence of SBI, whereas HR infants have an occurrence of 21%. The occurrence of SBI in Rochester LR or HR infants with confirmed viral infections is unknown. The objective of this study was to determine the occurrence of SBI in Rochester LR and HR infants with and without viral infections.Methods. All febrile infants who were 90 days or younger and evaluated at Primary Children's Medical Center between December 1996 and June 2002 were eligible. Infants were classified as Rochester LR or HR, and discharge diagnoses were collected. Viral testing for enteroviruses, respiratory viruses, rotavirus, and herpesvirus was performed as indicated by study protocol, clinical presentation, and season of the year.Results of all bacterial cultures were reviewed. Results. Of 1779 infants enrolled, 1385 (78%) had some form of viral diagnostic testing and 491 (35%) had 1 or more viruses identified. By the Rochester criteria, 456 (33%) infants were classified as LR and 922 (67%) infants as HR. For infants with viral infections, the occurrence of SBI was significantly lower than in infants without a viral infection (4.2% vs 12.3%). Rochester HR virus-positive (HR+) infants had significantly fewer bacterial infections than HR virus-negative (HR-) infants (5.5% vs 16.7%). When compared with HR- infants, HR+ infants were less likely to have bacteremia, urinary tract infection, or soft tissue infections, and HR+ infants had a similar occurrence of bacteremia as LR infants (0.92% vs 1.97%).Conclusions. Febrile infants with confirmed viral infections are at lower risk for SBI than those in whom a viral infection is not identified. Viral diagnostic data can positively contribute to the management of febrile infants, especially those who are classified as HR.