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Invasive bacterial infection in febrile neonates with influenza infection
Arantxa Aparicio Coll1, Lorena Algarrada Vico1, Ariadna Rigalós Cases1
1Área de Urgencias Pediátricas, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.
Insights
The prevalence of invasive bacterial infection (IBI) in febrile neonates with influenza is very low (0.9%). This study suggests a less aggressive approach may be possible for low-risk infants with influenza.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neonatology
Background:
- Febrile infants with viral infections have a lower risk of invasive bacterial infections (IBI).
- Current guidelines recommend individualized screening for IBI in infants 1-3 months, but not specifically for neonates.
- The study aimed to determine IBI prevalence in febrile neonates with influenza.
Purpose of the Study:
- To determine the prevalence of invasive bacterial infections (IBI) in febrile neonates diagnosed with influenza.
- To assess the incidence of specific IBI, including bacterial meningitis and urinary tract infections.
Main Methods:
- An observational, descriptive study was conducted over 21 years (2004-2023).
- Included febrile infants (<29 days) diagnosed with influenza, excluding those with abnormal pediatric assessment or recent antibiotic use.
- Data collected included blood cultures, urine cultures, and lumbar punctures.
Main Results:
- 112 neonates were included; 91.1% were hospitalized, and 59.8% received antibiotics.
- One neonate (0.9%) had an IBI (Escherichia coli bloodstream infection).
- 7 neonates (6.3%) had a urinary tract infection; no bacterial meningitis cases were found.
Conclusions:
- The prevalence of invasive bacterial infection (IBI) in febrile neonates with influenza is very low.
- No cases of bacterial meningitis were detected, supporting a potentially less aggressive management strategy.
- Further multicenter studies are needed to confirm findings and identify risk factors.
Introduction:
Febrile infants with a confirmed viral infection are at lower risk of an invasive bacterial infection (IBI). Several authors recommend individualizing screening in febrile infants aged 1 to 3 months, but there are currently no specific recommendations for neonates. The objective of our study was to determine the prevalence of IBI in febrile neonates with influenzavirus infection.
Methods:
Observational descriptive study in febrile infants aged less than 29 days managed in the emergency department with a microbiological diagnosis of influenza over a 21-year period (2004-2023). We excluded patients with an abnormal pediatric assessment triangle or who had received antibiotherapy in the past week.
Results:
The sample included 112 patients. Urine culture was performed in all, blood culture in 108 (96.4%) and lumbar puncture in 61 (54.5%). A total of 102 (91.1%) were admitted to hospital, of who 61 (59.8%) received antibiotics. An IBI was identified in one patient (prevalence 0.9%; 95% CI, 0.2%-4.9%): a female aged 8 days with a bloodstream infection by Escherichia coli. Additionally, 7 (6.3%, 95% CI: 3.1%-12.3%) patients presented with a urinary tract infection.
Conclusions:
The prevalence of IBI in febrile neonates with influenza infection is very low, with no detection of cases of bacterial meningitis. Confirmation of these results in a multicenter study, which could also identify associated risk factors, would allow a less aggressive approach of low-risk patients.
