Ralston Shawn, Hill Vanessa, Waters Ami
University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
Arch Pediatr Adolesc Med. 2011 Oct;165(10):951-6. doi: 10.1001/archpediatrics.2011.155.
To summarize the risk of occult serious bacterial infection in the youngest febrile infants presenting with either clinical bronchiolitis or respiratory syncytial virus infection.
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.
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.
Admission for bronchiolitis.
Age-specific rates of urinary tract infection, bacteremia, and meningitis were extracted.
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.
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.
总结患有临床毛细支气管炎或呼吸道合胞病毒感染的最小龄发热婴儿发生隐匿性严重细菌感染的风险。
我们对Medline数据库进行了系统检索，以查找报告90日龄以下患有临床毛细支气管炎和/或呼吸道合胞病毒感染的婴儿严重细菌感染发生率的研究。
分析报告就诊时进行的培养并提供分母（即每种培养类型获得的总数）的研究。
毛细支气管炎入院。
提取特定年龄的尿路感染、菌血症和脑膜炎发生率。
在分析的11项研究中，最小龄婴儿尿路感染的加权发生率为3.3%（95%置信区间，1.9%-5.7%）。11项研究中的8项未报告菌血症病例。所有研究均未报告脑膜炎病例。由于这些样本中零事件过多，未提供脑膜炎和菌血症的汇总统计数据。
对患有毛细支气管炎或呼吸道合胞病毒感染的发热婴儿进行严重细菌感染培养的筛查方法阳性率很低。尿培养细菌阳性率仍然较高，尽管无症状菌尿可能会混淆这些结果。
