Sepsis Workup in Febrile Infants 0–90 Days of Age With Respiratory Syncytial Virus Infection

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Abstract
To ascertain the incidence, determinants, and outcome of sepsis workup in febrile infants aged 0-90 days with respiratory syncytial virus (RSV) infection. Retrospective chart review. 191 infants with RSV, 21.5% younger than 28 days, were identified; 101 (52.9%) were febrile and 90 were afebrile. Among the febrile infants, 84.2% had blood cultures, 68.3% had urine cultures, and 58.4% had lumbar punctures. Complete sepsis workup was done in 52.5% of the febrile cohort, including 77.3% of those aged less than 28 days. There were 5 cases of urinary tract infection (UTI) [7.2%, 95% confidence interval (CI) = 2.4-16.1] and 1 case of bacteremia (1.2%, 95% CI = 0.0-6.4) among the tested febrile patients. There was no case (0%, 95% CI = 0.0-6.1) of meningitis. Age, maximum temperature, irritability, apnea, decreased intake, chest x-ray findings, and white blood cell count were not predictive of a positive culture. Only 7.8% of the afebrile patients had complete sepsis workup. Fever [risk ratio (RR) = 5.8, 95% CI = 2.8-12], absence of wheezing (RR = 2.1, 95% CI = 1.3-3.6), and age less than 28 days (RR = 1.6, 95% CI = 1.2-2.2) were independent predictors of complete sepsis workup. Overall, complete sepsis workup was associated with a higher rate of antibiotic use (RR = 10.7, 95% CI = 4.9-23.4), increased hospitalization (RR = 2.1, 95% CI = 1.0-4.7), and prolonged hospital stay (median of 2 days vs. 1 day, P = 0.003) compared with those without complete workup. Considerable variability exists in the sepsis workup of febrile infants with suspected RSV infection at our site. Concomitant UTIs are common in febrile, RSV-infected infants.