Sepsis workup in febrile infants 0-90 days of age with respiratory syncytial virus infection.

OBJECTIVES

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

DESIGN

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.

CONCLUSION

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.