title: Occult serious bacterial infection in infants younger than 60 to 90 days with bronchiolitis: a systematic review.
abstract: OBJECTIVE
  To summarize the risk of occult serious bacterial infection in the youngest febrile infants presenting with either clinical bronchiolitis or respiratory syncytial virus infection.
  
  
  METHODS
  We performed a systematic search of the Medline database for studies reporting rates of serious bacterial infection in infants younger than 90 days with clinical bronchiolitis and/or respiratory syncytial virus infection.
  
  
  METHODS
  Studies reporting on cultures performed at the time of presentation to care and providing a denominator, ie, total number of each type of culture obtained, were analyzed.
  
  
  METHODS
  Admission for bronchiolitis.
  
  
  METHODS
  Age-specific rates of urinary tract infection, bacteremia, and meningitis were extracted.
  
  
  RESULTS
  The weighted rate of urinary tract infections in the youngest infants in the 11 studies analyzed was 3.3% (95% confidence interval, 1.9%-5.7%). No case of bacteremia was reported in 8 of 11 studies. No case of meningitis was reported in any of the studies. Summary statistics for meningitis and bacteremia are not provided because of an excess of zero events in these samples.
  
  
  CONCLUSIONS
  A screening approach to culturing for serious bacterial infections in febrile infants presenting with bronchiolitis or respiratory syncytial virus infection is very low yield. The rate of urine cultures positive for bacteria remains significant, though asymptomatic bacteriuria may confound these results.
authors.affiliation: University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA. ralstons@uthscsa.edu
authors.forename: Shawn
authors.initials: S
authors.lastname: Ralston
authors.forename: Vanessa
authors.initials: V
authors.lastname: Hill
authors.forename: Ami
authors.initials: A
authors.lastname: Waters
mesh_terms: D016470:Bacteremia / Q000209:etiology; D001424:Bacterial Infections / Q000150:complications*; D001990:Bronchiolitis, Viral / Q000150:complications*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016920:Meningitis, Bacterial / Q000150:complications; D018357:Respiratory Syncytial Virus Infections / Q000150:complications*; D014552:Urinary Tract Infections / Q000150:complications