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Secondary bacterial infections less prevalent among young febrile infants with influenza

Issue: September 2009

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Findings from a prospective, multicenter study involving 1,091 infants indicated that febrile infants aged 60 days or younger who had influenza had a significantly lower prevalence of secondary bacterial infections and urinary tract infection compared with infants who tested negative for the virus.

Researchers from several U.S. pediatric emergency departments determined secondary bacterial infection status — defined as presence of a urinary tract infection (UTI), bacteremia, bacterial meningitis or bacterial enteritis — using blood, urine, cerebrospinal and stool samples among 884 infants who were screened for influenza using rapid antigen detection. They determined the following disease rates:

• Overall secondary bacterial infections — 95 of 809 evaluable infants, or 11.7% (95% CI: 9.6-4.2).
• UTI —overall, 80 of 835, or 9.6%; influenza-positive, 2.4%; influenza-negative, 10.8%.
• Bacteremia — overall, 16 of 838, or 1.9%; influenza-positive, 0; influenza-negative, 2.2%.
• Bacterial meningitis — 1 of 64, or 1.6%; influenza-positive, 0; influenza-negative, 0.9%.

“This has potential implications for the laboratory evaluation of young febrile infants younger than 1 month of age with influenza virus infections,” Krief et al wrote. “Point-of-care testing for the influenza virus may aid the clinician in the evaluation of these infants and, therefore, should be considered.”

Krief WI et al. Pediatrics. 2009;124:30-39.

The study by Krief et al provides reassuring information that young children < 60 days of age infected with influenza virus, as determined by rapid antigen detection or viral culture methods, rarely have concomitant bacteremia or meningitis when they present for admission. However, while both rapid antigen detection and culture are very specific for the diagnosis of influenza, they both lack sensitivity when compared with new molecular diagnostic methods such as polymerase chain reaction. The authors stress that “larger studies are needed to evaluate with greater confidence the risk of bacteremia and meningitis in infants infected with influenza virus.” These studies should optimally be conducted using molecular diagnostic methods to confirm the diagnosis of influenza.

– Kathryn M. Edwards, MD

Vanderbilt Kennedy Center

Nashville, Tennessee