45 - Concomitant Serious Bacterial (SBI) and Viral (VI) Infections in Febrile Infants (FI) < 90 Days of Age: A Probabilistic Approach.

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 45
Publication Number: 45.112

Stephen Aronoff, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States

Presenting Author(s)

SA

Stephen Aronoff, MD, MBA (he/him/his)

Waldo E, Nelson Professor AND Chairperson Department of Pediatrics
Lewis Katz School of Medicine at Temple University
Philadelphia, Pennsylvania, United States

Background:

The high rate of SBI among FI < 90 days of age has been well documented. Studies have shown that the rate of SBI among febrile infants with documented VI (SBI+VI) is less than the rate of SBI leading to speculation as to the cause of this phenomenon.

Objective:

This study was undertaken to determine whether coinfections represented the joint occurrence of two independent processes.

Design/Methods:

A systematic review of PubMed and Embase using the terms “serious bacterial infection”, “fever”, “infant”, and “(viral OR virus)” and the filter “Newborn” was undertaken to identify articles that met the following criteria: < 90 days of age, previously healthy, any viral testing plus bacterial testing in all subjects, and observational design. The product rule for joint probabilities of independent events was used to calculate predicted rates of VI + SBI. The relationship between the observed and predicted rates was determined by simple linear regression.

		Observed SBI + VI	Predicted SBI + VI
Study	n	Observed SBI + VI	Predicted SBI + VI
Greenfield, AJEM 50: 744, 2021	597	0.047	0.039
Kreif, Pediatrics 124:30, 2009	809	0.045	0.035
Mahajan, J Pediatr 203:86, 2018	2945	0.037	0.037
Nicholson, PIDJ 38:355, 2019	104	0.129	0.110
Byington, Pediatrics. 113:1662, 2004	1385	0.043	0.034
Aronson, Pediatrics 150: 2022	9112	0.011	0.020
Paret, Pediatrics 148: 2021	114	0.200	0.058
Bonadio, PedEmergCare 32:286,2016	411	0.098	0.027
Bilavsky, PIDJ 27:269, 2008	448	0.024	0.013
Levine Pediatrics 113:1728, 2004	1169	0.063	0.026

Results: 236 references were identified; 10 were included. The SBI+VI rates are shown in the table.

Regression of the observed rate of SBI + VI was statistically significant (R²= .40, p = .048)

Conclusion(s):

Conclusions: This study supports modeling the SBI+VI rate as the joint probability of independent events which has implications for estimating SBI risk in FI < 90 days of age during high community rates of VI.