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December 1997, Vol 151, No. 12 >
Article | December 1997

Risks for Bacteremia and Urinary Tract Infections in Young Febrile Children With Bronchiolitis FREE

Nathan Kuppermann, MD, MPH; David E. Bank, MD; Edward A. Walton, MD; Melvin O. Senac, MD; Ian McCaslin, MD
[+] Author Affiliations

The affiliations of the authors appear in the acknowledgment section at the end of the article.


Arch Pediatr Adolesc Med. 1997;151(12):1207-1214. doi:10.1001/archpedi.1997.02170490033006.
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References
Comments

Objective:  To compare the risks for bacteremia and urinary tract infections (UTI) in young febrile children with and without bronchiolitis.

Design:  A prospective cohort study.

Setting:  The emergency departments of 3 pediatric referral hospitals.

Patients:  A convenience sample of 432 previously healthy febrile patients aged 24 months or younger. Patients were divided into groups, based on the presence (n=163, bronchiolitis group) or absence (n=269, control group) of wheezing and/or retractions on examination. Blood cultures were obtained from all patients, and urine cultures were obtained from female patients, and male patients aged 6 months or younger. Chest radiographs were obtained on patients with lower respiratory tract signs, and those with lobar pneumonias were excluded (7 wheezing and 8 nonwheezing patients), leaving 156 patients with bronchiolitis and 261 control patients.

Outcome Measures:  Growth of any bacterial pathogens from the blood or 104 colony-forming units per milliliter or more from the urine.

Results:  None of the 156 patients with bronchiolitis had bacteremia (95% confidence interval, 0%-1.9%) vs 2.7% of the 261 controls (95% confidence interval, 1.1%-5.4%; P=.049); 1.9% of the patients with bronchiolitis had UTI vs 13.6% of the controls (odds ratio, 0.12; 95% confidence interval, 0.02-0.55; P=.001). None of the subset of patients with bronchiolitis aged 2 months or younger (n=36) had bacteremia or UTI; however, there were not enough of these younger patients to make statistically conclusive comparisons.

Conclusions:  Previously healthy febrile children aged 24 months or younger with bronchiolitis are unlikely to have bacteremia or UTI. Therefore, routine cultures of the blood and urine in these patients are unnecessary. More data are needed regarding the subset of febrile infants aged 2 months or younger with bronchiolitis.Arch Pediatr Adolesc Med. 1997;151:1207-1214

REFERENCES

1 +
McGowan JE, Bratton L, Klein JO, Finland M.  Bacteremia in febrile children seen in a 'walk-in' pediatric clinic . N Engl J Med . 1973;;288:1309-1312.
2 +
McCarthy PL, Grundy GW, Spiesel SZ, Dolan TF Jr.  Bacteremia in children: an outpatient clinical review . Pediatrics . 1976;;57:861-869.
3 +
Krauss BS, Harakal T, Fleisher GR.  The spectrum and frequency of illness presenting to a pediatric emergency department . Pediatr Emerg Care . 1991;;7:67-71.
4 +
Nelson DS, Walsh K, Fleisher GR.  Spectrum and frequency of pediatric illness presenting to a general community hospital emergency department . Pediatrics . 1992;;90:5-10
5 +
Baraff LJ, Bass JW, Fleisher GR, et al.  Practice guideline for the management of infants and children 0 to 36 months of age with fever without source . Pediatrics . 1993;;92:1-12.
6 +
Eden AN, Kaufman A, Yu R.  Corticoteroids and croup: controlled double-blind study . JAMA . 1967;;200:133-134.
7 +
James JA.  Dexamethasone in croup: a controlled study . AJDC . 1969;;117:511-516.
8 +
Balfour HH Jr, Kelly JM. Suarez CS, et al.  Acyclovir treatment of varicella in otherwise healthy children . J Pediatr . 1990;;116:633-639.
9 +
Dunkle LM, Arvin AM, Whitley RJ, et al.  A controlled trial of acyclovir for chickenpox in normal children . N Engl J Med . 1991;;325:1539-1544.
10 +
Balfour HH Jr, Rotbart HA, Feldman S, et al.  Acyclovir treatment of varicella in otherwise healthy adolescents . J Pediatr . 1992;;120:627-633.
11 +
Cherry JD.  Croup . In: Feigin RD, Cherry JD, eds. Textbook of Pediatric Infectious Diseases . Philadelphia, Pa: WB Saunders Co; 1992;:209-219.
12 +
Brunell PA.  Varicella-zoster infections . In: Feigin RD, Cherry JD, eds. Textbook of Pediatric Infectious Diseases . Philadelphia, Pa: WB Saunders Co; 1992;:1587-1591.
13 +
Kohl S.  Postnatal herpes simplex virus infection . In: Feigin RD, Cherry JD, eds. Textbook of Pediatric Infectious Diseases . Philadelphia, Pa: WB Saunders Co; 1992;:1558-1583.
14 +
Teele DW, Pelton SI, Grant MJA, et al.  Bacteremia in febrile children under 2 years of age: results of cultures of blood of 600 consecutive febrile children seen in a 'walk-in' clinic . J Pediatr . 1975;;87:227-230.
15 +
Teele DW, Marshall R, Klein JO.  Unsuspected bacteremia in young children: a common and important problem . Pediatr Clin North Am . 1979;;26:773-784.
16 +
Crain EF, Shelov SP.  Febrile infants: predictors of bacteremia . J Pediatr . 1982;; 101:686-689.
17 +
Woods ER, Merola JL, Bithoney WG, Spivak H, Wise PH.  Bacteremia in an ambulatory setting: improved outcome in children treated with antibiotics . AJDC . 1990;;144:1195-1199.
18 +
Hoberman A, Chao H, Keller DM, Hickey R, Davis HW, Ellis D.  Prevalence of urinary tract infection in febrile infants . J Pediatr . 1993;;123:17-23.
19 +
Jaffe DM.  Occult bacteremia in children . Adv Pediatr Infect Dis . 1994;;9:237-260.
20 +
Hall CB, Douglas RG Jr.  Nosocomial influenza infection as a cause of intercurrent fevers in infants . Pediatrics . 1975;;55:673-677.
21 +
Wright PF, Thompson J, McKee KT, Vaughn WK, Sell SHW, Karzon DT.  Patterns of illness in the highly febrile young child: epidemiologic, clinical and laboratory correlates . Pediatrics . 1981;;67:694-700.
22 +
Dagan R, Powell KR, Hall CB, Menegus MA.  Identification of infants unlikely to have serious bacterial infection although hospitalized for suspected sepsis . J Pediatr . 1985;;107:855-860.
23 +
Hall CB, Powell KR, Schnabel KC, Gala CL, Pincus PH.  Risk of secondary bacterial infection in infants hospitalized with respiratory syncytial viral infection . J Pediatr . 1988;;113:266-271.
24 +
Van-Lierde S, Corbeel L, Eggermont E.  Clinical and laboratory findings in children with adenovirus infections . Eur J Pediatr . 1989;;148:423-425.
25 +
Shaw KN, Bell LM, Sherman NH.  Outpatient assessment of infants with bronchiolitis . AJDC . 1991;;145:151-155.
26 +
Baker MD, Bell LM, Avner JR.  Outpatient management without antibiotics of fever in selected infants . N Engl J Med . 1993;;329:1437-1441.
27 +
Nichol KP, Cherry JD.  Bacterial-viral interrelations in respiratory infections of children . N Engl J Med . 1967;;277:667-672.
28 +
Zollar LM, Krause HE, Mufson MA.  Microbiologic studies on young infants with lower respiratory tract disease . AJDC . 1973;;126:56-60.
29 +
Friis B, Anderson P, Brenoe E, et al.  Antibiotic treatment of pneumonia and bronchiolitis: a prospective randomised study . Arch Dis Child . 1984;;59:1038-1045.
30 +
Paisley JW, Lauer BA, McIntosh K, Glode MP, Schachter J, Rumack C.  Pathogens associated with acute lower respiratory tract infection in young children . Pediatr Infect Dis J . 1984;;3:14-19.
31 +
Shann F, Germer S, Hazlett D, Gratten M, Linnemann V, Payne R.  Aetiology of pneumonia in children in Goroka Hospital, Papua New Guinea . Lancet . 1984;;2: 537-541.
32 +
Timmons OD, Yamauchi T, Collins SR, Newbern DG, Sweatt JA, Jacobs RF.  Association of respiratory syncytial virus and Streptococcus pneumoniae infection in young infants . Pediatr Infect Dis J . 1987;;6:1134-1135.
33 +
Tristram DA, Miller RW, McMillan JA, Weiner LB.  Simultaneous infection with respiratory syncytial virus and other respiratory pathogens . AJDC . 1988;;142: 834-836.
34 +
Claesson BA, Trollfors B, Brolin I, et al.  Etiology of community-acquired pneumonia in children based on antibody responses to bacterial and viral antigens . Pediatr Infect Dis J . 1989;;8:856-862.
35 +
Ghafoor A, Nomani NK, Ishaq Z, et al.  Diagnoses of acute lower respiratory tract infections in children in Rawalpindi and Islamabad, Pakistan . Rev Infect Dis . 1990;; 12( (suppl 8) ):S907-S914.
36 +
Berman S.  Epidemiology of acute respiratory infections in children of developing countries . Rev Infect Dis . 1991;;13( (suppl 6) ):S454-S462.
37 +
Hubert B, Watier L, Garnerin P, Richardson S.  Meningococcal disease and influenzalike syndrome: a new approach to an old question . J Infect Dis . 1992;;166:542-545.
38 +
Murtagh P, Cerqueiro C, Halac A, Avila M, Salomon H, Weissenbacher M.  Acute lower respiratory infection in Argentinian children: a 40 month clinical and epidemiological study . Pediatr Pulmonol . 1993;;16:1-8.
39 +
Abbasi S, Pendergrass LB, Leggiadro RJ.  Influenza complicated by Moraxella catarrhalis bacteremia . Pediatr Infect Dis J . 1994;;13:937-938.
40 +
Mills EL.  Viral infections predisposing to bacterial infections . Ann Rev Med . 1984;; 35:469-479.
41 +
Abramson JS, Wheeler JG.  Virus-induced neutrophil dysfunction: role in the pathogenesis of bacterial infections . Pediatr Infect Dis J . 1994;;13:643-652.
42 +
Panitch HB, Callahan CW Jr, Schidlow DV.  Bronchiolitis in children . Clin Chest Med . 1993;;14:715-731.
43 +
Schutzman SA, Petrycki S, Fleisher GR.  Bacteremia with otitis media . Pediatrics . 1991;;87:48-53.
44 +
McCarthy PL, Sharpe MR, Spiesel SZ, et al.  Observation scales to identify serious illness in febrile children . Pediatrics . 1982;;70:802-809.
45 +
Tal A, Bavilski C, Yohai D, Bearman JE, Gorodischer R, Moses SW.  Dexamethasone and salbutamol in the treatment of acute wheezing in infants . Pediatrics . 1983;;71:13-18.
46 +
StataCorp. Stata Statistical Software. Release 4.0 . College Station, Tex: Stata Corporation; 1995;.
47 +
Roberts KB, Charney E, Sweren RJ, et al.  Urinary tract infection in infants with unexplained fever: a collaborative study . J Pediatr . 1983;;103:864-867.
48 +
Hoberman A, Wald ER, Reynolds EA, Penchansky L, Charron M.  Is urine culture necessary to rule out urinary tract infection in young febrile children? Pediatr Infect Dis J . 1996;;15:304-309.
49 +
Shaw KN, McGowan KL, Gorelick MH, Schwartz JS.  Screening for urinary tract infection in young febrile children in the emergency department: which test is best? Arch Pediatr Adolesc Med . 1996;;150:37A.
50 +
Davies HD, Matlow A, Petric M, Glazier R, Wang EEL.  Prospective comparative study of viral, bacterial, and atypical organisms identified in pneumonia and bronchiolitis in hospitalized Canadian infants . Pediatr Infect Dis J . 1996;;15:371-375.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
McGowan JE, Bratton L, Klein JO, Finland M.  Bacteremia in febrile children seen in a 'walk-in' pediatric clinic . N Engl J Med . 1973;;288:1309-1312.
2 +
McCarthy PL, Grundy GW, Spiesel SZ, Dolan TF Jr.  Bacteremia in children: an outpatient clinical review . Pediatrics . 1976;;57:861-869.
3 +
Krauss BS, Harakal T, Fleisher GR.  The spectrum and frequency of illness presenting to a pediatric emergency department . Pediatr Emerg Care . 1991;;7:67-71.
4 +
Nelson DS, Walsh K, Fleisher GR.  Spectrum and frequency of pediatric illness presenting to a general community hospital emergency department . Pediatrics . 1992;;90:5-10
5 +
Baraff LJ, Bass JW, Fleisher GR, et al.  Practice guideline for the management of infants and children 0 to 36 months of age with fever without source . Pediatrics . 1993;;92:1-12.
6 +
Eden AN, Kaufman A, Yu R.  Corticoteroids and croup: controlled double-blind study . JAMA . 1967;;200:133-134.
7 +
James JA.  Dexamethasone in croup: a controlled study . AJDC . 1969;;117:511-516.
8 +
Balfour HH Jr, Kelly JM. Suarez CS, et al.  Acyclovir treatment of varicella in otherwise healthy children . J Pediatr . 1990;;116:633-639.
9 +
Dunkle LM, Arvin AM, Whitley RJ, et al.  A controlled trial of acyclovir for chickenpox in normal children . N Engl J Med . 1991;;325:1539-1544.
10 +
Balfour HH Jr, Rotbart HA, Feldman S, et al.  Acyclovir treatment of varicella in otherwise healthy adolescents . J Pediatr . 1992;;120:627-633.
11 +
Cherry JD.  Croup . In: Feigin RD, Cherry JD, eds. Textbook of Pediatric Infectious Diseases . Philadelphia, Pa: WB Saunders Co; 1992;:209-219.
12 +
Brunell PA.  Varicella-zoster infections . In: Feigin RD, Cherry JD, eds. Textbook of Pediatric Infectious Diseases . Philadelphia, Pa: WB Saunders Co; 1992;:1587-1591.
13 +
Kohl S.  Postnatal herpes simplex virus infection . In: Feigin RD, Cherry JD, eds. Textbook of Pediatric Infectious Diseases . Philadelphia, Pa: WB Saunders Co; 1992;:1558-1583.
14 +
Teele DW, Pelton SI, Grant MJA, et al.  Bacteremia in febrile children under 2 years of age: results of cultures of blood of 600 consecutive febrile children seen in a 'walk-in' clinic . J Pediatr . 1975;;87:227-230.
15 +
Teele DW, Marshall R, Klein JO.  Unsuspected bacteremia in young children: a common and important problem . Pediatr Clin North Am . 1979;;26:773-784.
16 +
Crain EF, Shelov SP.  Febrile infants: predictors of bacteremia . J Pediatr . 1982;; 101:686-689.
17 +
Woods ER, Merola JL, Bithoney WG, Spivak H, Wise PH.  Bacteremia in an ambulatory setting: improved outcome in children treated with antibiotics . AJDC . 1990;;144:1195-1199.
18 +
Hoberman A, Chao H, Keller DM, Hickey R, Davis HW, Ellis D.  Prevalence of urinary tract infection in febrile infants . J Pediatr . 1993;;123:17-23.
19 +
Jaffe DM.  Occult bacteremia in children . Adv Pediatr Infect Dis . 1994;;9:237-260.
20 +
Hall CB, Douglas RG Jr.  Nosocomial influenza infection as a cause of intercurrent fevers in infants . Pediatrics . 1975;;55:673-677.
21 +
Wright PF, Thompson J, McKee KT, Vaughn WK, Sell SHW, Karzon DT.  Patterns of illness in the highly febrile young child: epidemiologic, clinical and laboratory correlates . Pediatrics . 1981;;67:694-700.
22 +
Dagan R, Powell KR, Hall CB, Menegus MA.  Identification of infants unlikely to have serious bacterial infection although hospitalized for suspected sepsis . J Pediatr . 1985;;107:855-860.
23 +
Hall CB, Powell KR, Schnabel KC, Gala CL, Pincus PH.  Risk of secondary bacterial infection in infants hospitalized with respiratory syncytial viral infection . J Pediatr . 1988;;113:266-271.
24 +
Van-Lierde S, Corbeel L, Eggermont E.  Clinical and laboratory findings in children with adenovirus infections . Eur J Pediatr . 1989;;148:423-425.
25 +
Shaw KN, Bell LM, Sherman NH.  Outpatient assessment of infants with bronchiolitis . AJDC . 1991;;145:151-155.
26 +
Baker MD, Bell LM, Avner JR.  Outpatient management without antibiotics of fever in selected infants . N Engl J Med . 1993;;329:1437-1441.
27 +
Nichol KP, Cherry JD.  Bacterial-viral interrelations in respiratory infections of children . N Engl J Med . 1967;;277:667-672.
28 +
Zollar LM, Krause HE, Mufson MA.  Microbiologic studies on young infants with lower respiratory tract disease . AJDC . 1973;;126:56-60.
29 +
Friis B, Anderson P, Brenoe E, et al.  Antibiotic treatment of pneumonia and bronchiolitis: a prospective randomised study . Arch Dis Child . 1984;;59:1038-1045.
30 +
Paisley JW, Lauer BA, McIntosh K, Glode MP, Schachter J, Rumack C.  Pathogens associated with acute lower respiratory tract infection in young children . Pediatr Infect Dis J . 1984;;3:14-19.
31 +
Shann F, Germer S, Hazlett D, Gratten M, Linnemann V, Payne R.  Aetiology of pneumonia in children in Goroka Hospital, Papua New Guinea . Lancet . 1984;;2: 537-541.
32 +
Timmons OD, Yamauchi T, Collins SR, Newbern DG, Sweatt JA, Jacobs RF.  Association of respiratory syncytial virus and Streptococcus pneumoniae infection in young infants . Pediatr Infect Dis J . 1987;;6:1134-1135.
33 +
Tristram DA, Miller RW, McMillan JA, Weiner LB.  Simultaneous infection with respiratory syncytial virus and other respiratory pathogens . AJDC . 1988;;142: 834-836.
34 +
Claesson BA, Trollfors B, Brolin I, et al.  Etiology of community-acquired pneumonia in children based on antibody responses to bacterial and viral antigens . Pediatr Infect Dis J . 1989;;8:856-862.
35 +
Ghafoor A, Nomani NK, Ishaq Z, et al.  Diagnoses of acute lower respiratory tract infections in children in Rawalpindi and Islamabad, Pakistan . Rev Infect Dis . 1990;; 12( (suppl 8) ):S907-S914.
36 +
Berman S.  Epidemiology of acute respiratory infections in children of developing countries . Rev Infect Dis . 1991;;13( (suppl 6) ):S454-S462.
37 +
Hubert B, Watier L, Garnerin P, Richardson S.  Meningococcal disease and influenzalike syndrome: a new approach to an old question . J Infect Dis . 1992;;166:542-545.
38 +
Murtagh P, Cerqueiro C, Halac A, Avila M, Salomon H, Weissenbacher M.  Acute lower respiratory infection in Argentinian children: a 40 month clinical and epidemiological study . Pediatr Pulmonol . 1993;;16:1-8.
39 +
Abbasi S, Pendergrass LB, Leggiadro RJ.  Influenza complicated by Moraxella catarrhalis bacteremia . Pediatr Infect Dis J . 1994;;13:937-938.
40 +
Mills EL.  Viral infections predisposing to bacterial infections . Ann Rev Med . 1984;; 35:469-479.
41 +
Abramson JS, Wheeler JG.  Virus-induced neutrophil dysfunction: role in the pathogenesis of bacterial infections . Pediatr Infect Dis J . 1994;;13:643-652.
42 +
Panitch HB, Callahan CW Jr, Schidlow DV.  Bronchiolitis in children . Clin Chest Med . 1993;;14:715-731.
43 +
Schutzman SA, Petrycki S, Fleisher GR.  Bacteremia with otitis media . Pediatrics . 1991;;87:48-53.
44 +
McCarthy PL, Sharpe MR, Spiesel SZ, et al.  Observation scales to identify serious illness in febrile children . Pediatrics . 1982;;70:802-809.
45 +
Tal A, Bavilski C, Yohai D, Bearman JE, Gorodischer R, Moses SW.  Dexamethasone and salbutamol in the treatment of acute wheezing in infants . Pediatrics . 1983;;71:13-18.
46 +
StataCorp. Stata Statistical Software. Release 4.0 . College Station, Tex: Stata Corporation; 1995;.
47 +
Roberts KB, Charney E, Sweren RJ, et al.  Urinary tract infection in infants with unexplained fever: a collaborative study . J Pediatr . 1983;;103:864-867.
48 +
Hoberman A, Wald ER, Reynolds EA, Penchansky L, Charron M.  Is urine culture necessary to rule out urinary tract infection in young febrile children? Pediatr Infect Dis J . 1996;;15:304-309.
49 +
Shaw KN, McGowan KL, Gorelick MH, Schwartz JS.  Screening for urinary tract infection in young febrile children in the emergency department: which test is best? Arch Pediatr Adolesc Med . 1996;;150:37A.
50 +
Davies HD, Matlow A, Petric M, Glazier R, Wang EEL.  Prospective comparative study of viral, bacterial, and atypical organisms identified in pneumonia and bronchiolitis in hospitalized Canadian infants . Pediatr Infect Dis J . 1996;;15:371-375.

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