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Rhinovirus affects bacterial infection risk as infants age
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Although human rhinovirus in febrile infants did not change the risk of bacterial infections in very young infants, it was a factor in the risk of invasive bacterial infection in infants aged 29 to 90 days, according to recently published research in Pediatrics.
"More than a third of infants 1 to 90 days old undergoing evaluation for fever that includes viral respiratory testing are positive for human rhinovirus (HRV), but it has been unclear how this information can be used to guide clinical care,” Anne J. Blaschke, MD, PhD, associate professor of pediatrics and pediatric infectious diseases, Edward B. Clark Endowed Chair in Pediatrics, program director of the Pediatric Infectious Diseases Fellowship Program and director of the Molecular Microbiology Laboratory at the University of Utah School of Medicine, told Infectious Diseases in Children.
“Our group at the University of Utah has been studying febrile infant management and diagnostic testing for a number of years, and had the ability with our large data set to try and answer this question. Our study found that detection of [HRV] did not change the risk of concomitant bacterial infection for very young infants (younger than 29 days) but did affect the risk of bloodstream infection and meningitis (but not urinary tract infection) in infants 29 to 90 days old.”
Blaschke and colleagues identified 10,964 well-appearing febrile infants aged 1 to 90 days in the ED or inpatient setting of 22 hospitals in the Intermountain Healthcare system from 2007 to 2016 who received respiratory viral testing by polymerase chain reaction (PVPCR). The researchers determined the relative risks of bacterial infection in infants with HRV, non-HRV viruses or having no detection of virus.
There were 4,037 febrile infants (37%) who received PVPCR, including 2,212 positive for respiratory virus and 1,392 for HRV. Bacterial infection was detected in 9.5% of infants and was more likely in the infants with HRV (7.8%) compared with the infants with non-HRV viruses (3.7%; RR = 2.21; 95% CI, 1.43-3.15).
There was an association with decreased urinary tract infection (UTI) risk in infants aged 29 to 90 days with non-HRV detection (2.5%) when compared with infants with no detection of virus (9.1%; RR = 0.36; 95% CI, 0.23-0.56). Infants in that age range with HRV detection had a 6.1% risk of UTI (RR = 0.78; 95% CI, 0.65-0.95).
There was a decreased risk of invasive bacterial infection in infants aged 29 to 90 days with HRV (RR = 0.52; 95% CI, 0.34-0.80).
“This information could be used to suggest a more limited evaluation for fever in well-appearing infants [greater than] 29 days old with rhinovirus,” Blaschke said. – Bruce Thiel
Disclosures: Blaschke reports having intellectual property and receiving royalties from BioFire Diagnostics through the University of Utah. Please see the full study for a list of other authors’ relevant financial disclosures.
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