Departments of Pediatrics,
Departments of Pediatrics.
Pediatrics. 2018 Feb;141(2). doi: 10.1542/peds.2017-2384. Epub 2018 Jan 17.
Febrile infants with viral respiratory infections have a reduced risk of bacterial infection compared with virus-negative infants. The risk of concomitant bacterial infection in febrile infants positive for human rhinovirus (HRV) by polymerase chain reaction (PCR) is unknown.
Infants 1-90 days old managed using the care process model for well-appearing febrile infants and with respiratory viral testing by PCR (RVPCR) in the emergency department or inpatient setting of 22 hospitals in the Intermountain Healthcare system from 2007-2016 were identified. Relative risk (RR) of bacterial infection was calculated for infants with HRV, non-HRV viruses, or no virus detected.
Of 10 964 febrile infants identified, 4037 (37%) had RVPCR. Of these, 2212 (55%) were positive for a respiratory virus; 1392 (35%) for HRV alone. Bacterial infection was identified in 9.5%. Febrile infants with HRV detected were more likely to have bacterial infection than those with non-HRV viruses (7.8% vs 3.7%; < .001; RR 2.12 [95% CI 1.43-3.15]). Risk of urinary tract infection was not significantly different for HRV-positive infants at any age, nor was risk of invasive bacterial infection (IBI; bacteremia and/or meningitis) meaningfully different for infants 1-28 day olds. Infants 29-90 days old with HRV had a decreased likelihood of IBI (RR 0.52 [95% CI 0.34-0.80]).
HRV is common in febrile infants. Detection did not alter risk of concomitant urinary tract infection at any age or risk of IBI in infants 1-28 days old. HRV detection may be relevant in considering risk of IBI for infants 29-90 days of age.
与病毒阴性婴儿相比，患有病毒性呼吸道感染的发热婴儿发生细菌感染的风险较低。通过聚合酶链反应（PCR）检测为人鼻病毒（HRV）阳性的发热婴儿并发细菌感染的风险尚不清楚。
本研究纳入了 2007 年至 2016 年期间，在 Intermountain Healthcare 系统的 22 家医院的急诊科或住院部接受管理的、表现良好的发热婴儿，采用护理流程模型进行管理，并通过 PCR（RVPCR）进行呼吸道病毒检测。计算了 HRV、非 HRV 病毒或未检测到病毒的婴儿发生细菌感染的相对风险（RR）。
在确定的 10964 例发热婴儿中，4037 例（37%）进行了 RVPCR。其中，2212 例（55%）呼吸道病毒检测阳性，1392 例（35%）仅 HRV 阳性。9.5%的婴儿检测出细菌感染。与感染非 HRV 病毒的婴儿相比，HRV 阳性的发热婴儿更易发生细菌感染（7.8%比 3.7%；<.001；RR 2.12[95%CI 1.43-3.15]）。任何年龄段的 HRV 阳性婴儿的尿路感染风险均无显著差异，1-28 日龄婴儿的侵袭性细菌感染（菌血症和/或脑膜炎）风险也无显著差异。29-90 日龄的 HRV 阳性婴儿发生 IBI 的可能性降低（RR 0.52[95%CI 0.34-0.80]）。
HRV 在发热婴儿中很常见。在任何年龄段，检测结果均未改变同时发生尿路感染的风险，也未改变 1-28 日龄婴儿发生 IBI 的风险。对于 29-90 日龄的婴儿，HRV 检测可能与 IBI 风险相关。
