Sepsis workup in febrile infants 0-90 days of age with respiratory syncytial virus infection.
OBJECTIVE
To ascertain the incidence, determinants, and outcome of sepsis workup in febrile infants aged 0-90 days with respiratory syncytial virus (RSV) infection.


METHODS
Retrospective chart review.


RESULTS
191 infants with RSV, 21.5% younger than 28 days, were identified; 101 (52.9%) were febrile and 90 were afebrile. Among the febrile infants, 84.2% had blood cultures, 68.3% had urine cultures, and 58.4% had lumbar punctures. Complete sepsis workup was done in 52.5% of the febrile cohort, including 77.3% of those aged less than 28 days. There were 5 cases of urinary tract infection (UTI) [7.2%, 95% confidence interval (CI) = 2.4-16.1] and 1 case of bacteremia (1.2%, 95% CI = 0.0-6.4) among the tested febrile patients. There was no case (0%, 95% CI = 0.0-6.1) of meningitis. Age, maximum temperature, irritability, apnea, decreased intake, chest x-ray findings, and white blood cell count were not predictive of a positive culture. Only 7.8% of the afebrile patients had complete sepsis workup. Fever [risk ratio (RR) = 5.8, 95% CI = 2.8-12], absence of wheezing (RR = 2.1, 95% CI = 1.3-3.6), and age less than 28 days (RR = 1.6, 95% CI = 1.2-2.2) were independent predictors of complete sepsis workup. Overall, complete sepsis workup was associated with a higher rate of antibiotic use (RR = 10.7, 95% CI = 4.9-23.4), increased hospitalization (RR = 2.1, 95% CI = 1.0-4.7), and prolonged hospital stay (median of 2 days vs. 1 day, P = 0.003) compared with those without complete workup.


CONCLUSIONS
Considerable variability exists in the sepsis workup of febrile infants with suspected RSV infection at our site. Concomitant UTIs are common in febrile, RSV-infected infants.
Bridgeport Hospital, Yals-New Haven Health, 267 Grant St., Bridgeport, CT 06610, USA.
Pinar
P
Oray-Schrom
Carlene
C
Phoenix
Dacelin
D
St  Martin
Yaw
Y
Amoateng-Adjepong
D016470:Bacteremia / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D001431:Bacteriological Techniques / Q000706:statistics & numerical data; D015331:Cohort Studies; D015897:Comorbidity; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005260:Female; D005334:Fever / Q000209:etiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D007958:Leukocyte Count / Q000706:statistics & numerical data; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D013902:Radiography, Thoracic / Q000706:statistics & numerical data; D018357:Respiratory Syncytial Virus Infections / Q000150:complications* / Q000453:epidemiology; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D013129:Spinal Puncture / Q000706:statistics & numerical data; D014552:Urinary Tract Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology