The Rochester criteria help physici...

The Rochester criteria help physicians triage febrile children into high- and low-risk categories, depending in succession how likely they are to have a serious bacterial infection. The expansion to which children with viral illness have a concomitant serious bacterial infection is not known, nor have any studies shown whether identifying a viral illness in febrile children resolve intos their risk of having a serious bacterial infection. Byington and colleagues examined whether children with viral illnesses are les likely to evolve serious bacterial infections than children without viral illness.

This prospective close attention enrolled infants one to 90 days of age with temperatures of at least 38[degrees]C (1004[degrees]F) testing them for respiratory viruses, including respiratory syncytial virus (RSV) All infants underwent a concluded septic work-up. Infants were assigned Rochester classifications (high-risk or low-risk) and were subsequently classified as having serious bacterial infection based forward bacterial culture results.

Viral testing was performed in 1385 infants, 491 (35 percent) of whom had single or more viral infections. Of the 1385 participants, 922 (67 percent) were classified as high-risk, and 456 (33 percent) were classified as low-risk; a determination could not be made in the remaining seven infants. Of the 1385 infants, 131 (95 percent) had a serious bacterial infection. Of the 491 virally infected children, 21 (42 percent) had a serious bacterial infection compared with 110 (123 percent) of the 894 children who were not virally infected.

Bacterial meningitis occurr in six children without viruses and in none of the children with viral infections. When these findings were combined with the Rochester classifications, high-risk infants with viral infections were significantly les likely to have serious bacterial infections than high-risk infants without viral infections. The casualty of serious bacterial infections was not significantly different in low-risk, virus-positive infants versus low-risk, virus-negative infants. High-risk virus-negative infants had a 1367 greater proceeding of serious bacterial infections than low-risk, virus-positive infants.

RSV and enteroviruses were the in the greatest degree commonly identified viruses. The authors point not at home that technology to identify these viruses is readily available. Thus, viral testing could be used as an additional tool to triage febrile infants. unruffled high-risk infants who are virally infected are les likely to have bacteremia, urinary tract infection, or soft-tissue infection, whereas high-risk children without viral infection are 35 times more likely to have a serious bacterial infection.

CAROLINE WELLBERY, MD

Byington CL et al. Serious bacterial infections in febrile infants 1 to 90 days antiquated with and without viral infections. Pediatrics June 2004;113:1662-6

COPYRIGHT 2005 American Academy of Family Physicians

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