2644. Presence of Respiratory Viruses in the Upper Respiratory Tract of Febrile Infants ≤90 Days Old is Associated with Lower Prevalence of Invasive Bacterial Infection
Authors: Nicholson Erin G , Stopczynski Tess , Sahni Leila C , Avadhanula Vasanthi , Piedra Pedro A , Amarin Justin Z , Chappell James , Klein Eileen J , Englund Janet A , Williams John V , Michaels Marian G , Weinberg Geoffrey A , Szilagyi Peter G , Schuster Jennifer E , Selvarangan Rangaraj , Staat Mary A , Schlaudecker Elizabeth P , Burkel Veronica , Moline Heidi L , Halasa Natasha B , Boom Julie A 
Published: November 2023

Abstract

Background
Infants ≤ 90 days old are at increased risk of severe disease from both viral and bacterial pathogens. Differentiating between these two etiologies has long presented a diagnostic challenge and has resulted in many risk algorithms to determine which infants are infected by bacteria and require antibiotics. The increased availability of rapid molecular diagnostics presents an opportunity to refine these algorithms. While the prevalence of urinary tract infection in the presence of a respiratory virus has been described, large-scale studies with comprehensive viral testing describing the prevalence of invasive bacterial infection (IBI), defined as bacteremia or bacterial meningitis, are lacking.

Methods
The CDC’s New Vaccine Surveillance Network (NVSN) enrolls children &lt; 18 years old with acute respiratory illness in the emergency department or inpatient setting of 7 hospitals. Upper respiratory specimens are collected and tested for respiratory viruses by real-time PCR. In this analysis respiratory viral positivity is described in febrile and non-febrile infants ≤ 90 days old. We then compared the prevalence of IBI (based on blood and CSF cultures obtained for clinical testing) among febrile infants with and without a respiratory virus detected. IBIs were defined as a positive blood or CSF culture with bacteria unlikely to be a contaminant.

Results
From December 2016 to March 2020, 3,731 infants (n=2,138 febrile, n=1,593 non-febrile) were enrolled. Respiratory viral positivity was 68% for febrile infants and 78% for non-febrile infants. Among febrile infants, 68% (n=1,461) had either a blood or CSF culture obtained; 3% (n=41) had an IBI. Febrile infants in whom a respiratory virus was detected, were significantly less likely to have an IBI (OR: 0.26 [95% CI: 0.13–0.52]) than febrile infants with negative viral testing (Table).

Conclusion
Detection of a respiratory virus in febrile infants ≤90 days is associated with significantly lower odds of an IBI (bacteremia or bacterial meningitis). These findings may help develop future risk algorithms for bacterial infection in febrile infants aged ≤90 days aiming to decrease unnecessary antibiotic use in this population.

Disclosures
Erin G. Nicholson, MD, MS, Blue Lake Biotechnology Inc.: Grant/Research Support|Novavax: Advisor/Consultant Pedro A. Piedra, MD, Ark Bioscience: Advisor/Consultant|Ark Bioscience: Grant/Research Support|GSK: Grant/Research Support|Icosavax: Advisor/Consultant|Icosavax: Grant/Research Support|Mapp Biologics: Grant/Research Support|Meissa Vaccines: Grant/Research Support|Moderna: Advisor/Consultant|Novavax: Advisor/Consultant|Novavax: Grant/Research Support|Sanofi-Pasteur: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Takeda: Advisor/Consultant Janet A. Englund, MD, Ark Biopharma: Advisor/Consultant|AstraZeneca: Advisor/Consultant|AstraZeneca: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Meissa Vaccines: Advisor/Consultant|Merck: Grant/Research Support|Moderna: Advisor/Consultant|Moderna: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant John V. Williams, MD, Merck: Grant/Research Support|Quidel: Board Member Marian G. Michaels, MD, MPH, Merck: Grant/Research Support|Viracor: Grant/Research Support Geoffrey A. Weinberg, MD, Merck & Co: Honoraria Rangaraj Selvarangan, BVSc, PhD, D(ABMM), FIDSA, FAAM, Abbott: Honoraria|Altona Diagnostics: Grant/Research Support|Baebies Inc: Advisor/Consultant|BioMerieux: Advisor/Consultant|BioMerieux: Grant/Research Support|Bio-Rad: Grant/Research Support|Cepheid: Grant/Research Support|GSK: Advisor/Consultant|Hologic: Grant/Research Support|Lab Simply: Advisor/Consultant|Luminex: Grant/Research Support Mary A. Staat, MD, MPH, CDC: Grant/Research Support|Cepheid: Grant/Research Support|Merck: Grant/Research Support|NIH: Grant/Research Support|Pfizer: Grant/Research Support|Up-To-Date: Honoraria Elizabeth P. Schlaudecker, MD, MPH, Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant Natasha B. Halasa, MD, MPH, Merck: Grant/Research Support|Quidell: Grant/Research Support|Quidell: donation of kits|Sanofi: Grant/Research Support|Sanofi: vaccine support