RSV positivity associated with reduced serious bacterial infection risk [Classics Series]

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1. RSV-positive infants were significantly less likely to have an SBI than those who tested negative (7% vs. 12.5%, RR 0.6, p < .05) and at reduced risk for SBI (OR 0.58).

2. Infants <28 days old were significantly more likely to have an SBI than older infants (10.1% vs. 5.5%).

Original Date of Publication: June 2004

Study Rundown: Serious bacterial infections (SBIs) such as meningitis and bacteremia, are sources of significant morbidity and mortality in febrile infants under two months of age. While many studies had investigated the risk factors for SBIs, at the time of this study, no researchers had investigated the potential interaction of viral infection in febrile infants on simultaneous SBI. This study investigated the risk of SBI in febrile infants diagnosed with respiratory syncytial virus (RSV) infections. RSV was associated with a reduced risk of concurrent SBI; however, many RSV-positive infants had simultaneous urinary tract infections and younger infants (<28 days old) were found to have statistically similar SBI rates regardless of RSV positivity. Potential clinical implications of this study include limiting testing for infants >1 month of age with RSV to urinalysis only, while continuing a full workup for younger infants regardless of their viral status.

Click to read the study in Pediatrics

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In-Depth [prospective cross-sectional study]: Data from 1,248 patients, <60 days of age and with rectal temperatures >38˚C, were gathered from 8 pediatric emergency departments (EDs) over a period of three years. Patients underwent a history and physical examination, rapid RSV testing by nasopharyngeal aspirate, and further workup, treatment, and imaging at the discretion of their physician. Data was analyzed by taking patient’s RSV status into account while also considering the presence of SBI defined as bacterial meningitis, bacteremia, urinary tract infection (UTI), or bacterial enteritis. 11.4% of all study participants were found to have SBI with 0.7% having bacterial meningitis, 2% having bacteremia, 9.1% having UTI, and 1.9% having bacterial enteritis. Infants who tested positive for RSV were significantly less likely to have an SBI than those who tested negative (7% vs. 12.5%, RR 0.6, p < .05). Further analysis indicated that RSV-positive patients were at significantly lower risk for SBI (OR 0.58). The highest concurrent bacterial infection was UTI, with 5.4% of RSV-positive infants having UTIs. In subanalysis, 82 RSV-positive infants <28 days old had SBIs, 6.1% of these infants had UTIs and 3.7% had bacteremia. There was no RSV-dependent significant difference between SBI rates in infants <28 days old. 187 RSV-positive infants 29-60 days old were found to have an SBI rate of 5.5%, all of which were UTIs. Infants <28 days old were significantly more likely to have an SBI than older infants (10.1% vs. 5.5%).

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