Aronson Paul L, Mahajan Prashant, Nielsen Blake, Olsen Cody S, Meeks Huong D, Grundmeier Robert W, Kuppermann Nathan
Section of Pediatric Emergency Medicine, Departments of Pediatrics and of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.
Departments of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, Michigan.
Pediatrics. 2025 Jul 1;156(1). doi: 10.1542/peds.2025-070617.
The objective of this study was to describe the prevalence of urinary tract infections (UTIs), bacteremia, and bacterial meningitis among febrile infants aged 61 to 90 days with and without respiratory viral infections.
We used data from the Pediatric Emergency Care Applied Research Network (PECARN) Registry, comprised of pediatric visits from 17 emergency departments. Our cohort included infants aged 61 to 90 days with temperatures of at least 38°C, urinalyses/urine dipsticks and/or blood cultures, and respiratory viral testing performed between January 1, 2012, and April 30, 2024. We calculated the prevalence, with 95% CIs, of UTIs, bacteremia, and bacterial meningitis, stratified by presence and types of respiratory viral infections.
We included 3678 visits; 1725 (46.9%) infants tested positive for respiratory viruses. Compared with viral-negative infants, respiratory viral-positive infants had a lower prevalence of UTIs (4.4% [95% CI 3.5-5.6%] vs 12.5% [95% CI 11.0-14.2%]) and bacteremia (1.0% [95% CI 0.5-1.8%] vs 3.0% [95% CI 2.1-4.1%]). No respiratory-viral positive infants had bacterial meningitis, whereas 4 viral-negative infants had meningitis. The prevalence of UTIs ranged from 2.2% to 5.2% in infants who tested positive for influenza, respiratory syncytial virus, or SARS-CoV-2, all lower than viral-negative infants. SARS-CoV-2 positive infants had a lower prevalence of bacteremia compared with SARS-CoV-2 negative infants (0.9% [95% CI 0.3-1.9%] vs 3.1% [95% CI 2.0-4.6%]).
The prevalence of bacterial infections is lower in respiratory virus-positive febrile infants aged 61 to 90 days. These findings may help inform use of respiratory viral testing in the evaluation for UTIs, bacteremia, and meningitis in this age group.
本研究的目的是描述61至90日龄发热婴儿中，合并和未合并呼吸道病毒感染的尿路感染（UTIs）、菌血症和细菌性脑膜炎的患病率。
我们使用了儿科急诊护理应用研究网络（PECARN）登记处的数据，该数据来自17个急诊科的儿科就诊记录。我们的队列包括61至90日龄、体温至少为38°C、进行了尿液分析/尿试纸检测和/或血培养以及呼吸道病毒检测的婴儿，检测时间为2012年1月1日至2024年4月30日。我们计算了尿路感染、菌血症和细菌性脑膜炎的患病率及95%置信区间（CIs），并按呼吸道病毒感染的存在情况和类型进行分层。
我们纳入了3678次就诊记录；1725名（46.9%）婴儿呼吸道病毒检测呈阳性。与病毒检测阴性的婴儿相比，呼吸道病毒检测呈阳性的婴儿尿路感染患病率较低（4.4% [95% CI 3.5 - 5.6%] 对12.5% [95% CI 11.0 - 14.2%]），菌血症患病率也较低（1.0% [95% CI 0.5 - 1.8%] 对3.0% [95% CI 2.1 - 4.1%]）。呼吸道病毒检测呈阳性的婴儿中无人患有细菌性脑膜炎，而4名病毒检测阴性的婴儿患有脑膜炎。流感、呼吸道合胞病毒或SARS-CoV-2检测呈阳性的婴儿中，尿路感染患病率在2.2%至5.2%之间，均低于病毒检测阴性的婴儿。与SARS-CoV-2检测阴性的婴儿相比，SARS-CoV-2检测呈阳性的婴儿菌血症患病率较低（0.9% [95% CI 0.3 - 1.9%] 对3.1% [95% CI 2.0 - 4.6%]）。
61至90日龄呼吸道病毒检测呈阳性的发热婴儿中，细菌感染的患病率较低。这些发现可能有助于指导该年龄组尿路感染、菌血症和脑膜炎评估中呼吸道病毒检测的应用。
