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Sepsis Workup in Febrile Infants 0–90 Days of Age With Respiratory Syncytial Virus Infection

Oray-Schrom, Pinar MD; Phoenix, Carlene MD; St. Martin, Dacelin MD; Amoateng-Adjepong, Yaw MD, MPH, PhD

doi: 10.1097/01.pec.0000092576.40174.28
Original Articles

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.

Bridgeport Hospital, Yals-New Haven Health, 267 Grant St., Bridgeport, CT 06610.

Address corresspondence and reprint requests to Yaw Amoateng-Adjepong, MD, MPH, PhD, Combined Medicine-Pediatrics Residency Program, Bridgeport Hospital, Yale New Haven Health, 267 Grant Street, Bridgeport, CT 06610. E-mail: Pyamoa@bpthosp.org.

© 2003 Lippincott Williams & Wilkins, Inc.