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Limitations of Comprehensive Respiratory Viral Testing in Managing Young Infants with Fever
Vincent Julien Chessex1, Florence Anne Barbey2, Patrick Haberstich2
1KSA Children's Hospital Aarau, Aarau, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland.
Insights
Comprehensive respiratory viral testing offers limited value for identifying serious bacterial infections (SBI) in febrile young infants. Established inflammatory markers and urinalysis are more effective for risk stratification in this population.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Diagnostics
- Epidemiology
Background:
- Febrile young infants (FYI) often undergo extensive testing to rule out serious bacterial infections (SBI).
- Respiratory viral infections are common in FYI and can mimic symptoms of SBI, complicating diagnosis.
- The utility of comprehensive respiratory viral testing for SBI risk stratification in FYI remains unclear.
Purpose of the Study:
- To evaluate the contribution of comprehensive respiratory viral testing to the risk stratification of febrile young infants.
- To determine if viral testing aids in the clinical management of febrile young infants.
- To compare the effectiveness of viral testing against established markers for SBI risk assessment.
Main Methods:
- Retrospective cohort study of 456 hospitalized febrile young infants (≤90 days or ≤52 6/7 postmenstrual weeks).
- Inclusion criteria: positive respiratory viral test or negative result from a comprehensive panel.
- Primary outcome: rates of serious bacterial infection (SBI), stratified by respiratory viral test results.
Main Results:
- Overall SBI rate was 15.4% (70/456), including bacteremia and meningitis.
- Infants with positive viral tests had an 11.9% SBI rate; significantly lower rates were seen only for influenza and RSV.
- 93% of SBI cases exhibited abnormal inflammatory markers or urinalysis, irrespective of viral test results.
Conclusions:
- Comprehensive respiratory viral testing has limited value for SBI risk stratification in febrile young infants.
- Viral testing does not appear to enhance clinical decision-making or replace established risk stratification methods.
- Targeted testing strategies may offer a more efficient use of healthcare resources for febrile young infants.
Objective:
To assess whether and when comprehensive respiratory viral testing contributes to risk stratification and management of febrile young infants (FYI).
Study Design:
Single-center, retrospective cohort study of hospitalized FYI, aged ≤90 days (born at term) or ≤52 6/7 postmenstrual weeks (born preterm), over a 5-year period. A total of 456 infants with either a positive respiratory viral test result, regardless of diagnostic assay, or a negative respiratory viral test result obtained by comprehensive panel were included in the final analysis. Main outcomes were serious bacterial infection (SBI) rates overall and in specific subsamples, stratified by viral test results. Rates were estimated assuming a binomial distribution, with confidence intervals derived from a normal approximation. Risk ratios with 95% confidence intervals were calculated using uncertainty propagation.
Results:
Among 456 FYI (mean age 41 days), 70 (15.4%) had SBI, including 6 cases of bacteremia and 1 of meningitis. Infants with a positive viral test result had an SBI rate of 11.9% (42/354), including 2 cases of bacteremia, with significantly lower rates observed only in those testing positive for influenza (6%) and respiratory syncytial virus (4%). Regardless of viral test results, 93% (65/70) of SBI cases had abnormal inflammatory markers or urinalysis. Invasive bacterial infections occurred in both virus-positive (2/354) and virus-negative infants (5/102).
Conclusions:
Comprehensive respiratory viral testing appears to have limited value for SBI risk stratification in FYI. It does not seem to support clinical decision-making or replace established risk stratification by inflammatory markers and urinalysis. Targeted testing may represent a more appropriate use of resources.
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