The prevalence of serious bacterial infections in infants 90 days and younger with viral respiratory tract infections

Abdullah I. Almojali; Musab S. Alshareef; Othman F. Aljadoa; Fahad F. Alotaibi; Emad M. Masuadi; Tahir K. Hameed

doi:10.15537/smj.2022.43.9.20220400

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Table 1

- Demographic data and clinical characteristics of the sample (N=322).

Characteristic	n (%)
Gender
Male	179 (55.6)
Female	143 (44.4)
Age group
0-28 days	90 (28.0)
29-59 days	125 (38.8)
60-90 days	107 (33.2)
Gestational age
Preterm	45 (14.0)
Term	277 (86.0)
Year
2019	217 (67.4)
2020	105 (32.6)
Previously healthy
No	71 (22.1)
Yes	250 (77.9)
Febrile
No	76 (23.6)
Yes	246 (76.4)
Hypoactivity
No	221 (68.6)
Yes	101 (31.4)
General appearance
Well	284 (88.2)
Ill	38 (11.8)

Values are presented as a number and percentage (%).

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Table 2

- Respiratory viral infections and serious bacterial infections.

Variable		n (%)
Viruses isolated
Single virus isolated		265 (82.3)
Multiple viruses isolated		57 (17.7)
Respiratory multiplex PCR result
RSV	158 (49.1)
Human rhinovirus/enterovirus	153 (47.5)
Influenza A/B	15 (4.7)
Corona HKU, 229E, NL63, and OC43	14 (4.4)
Adenovirus	12 (3.8)
Parainfluenza virus 1,2,3, and 4	10 (3.1)
Bordetella Pertussis	8 (2.5)
Human metapneumovirus	6 (1.9)
SARS-CoV-2	6 (1.9)
Urine culture
No growth	269 (83.5)
Not done	30 (9.3)
Escherichia coli	13 (4.0)
Klebsiella several species	5 (1.6)
Candida	2 (0.6)
Staphylococcus aureus	1 (0.3)
Enterobacter cloacae	1 (0.3)
Citrobacter koseri	1 (0.3)
Blood culture
No growth	285 (88.5)
Not carried out	26 (8.1)
Staphylococcus hominis*	7 (2.2)
Staphylococcus epidermidis*	3 (0.9)
Staphylococcus salivarius*	1 (0.3)
CSF PCR/culture results
Not carried out	143 (44.4)
Negative	141 (43.8)
Refused	19 (6.0)
Failed	8 (2.5)
Enterovirus	7 (2.2)
Human herpesvirus 6	3 (0.9)
Staphylococcus epidermidis*	1 (0.3)

Values are presented as a number and percentage (%). *Contaminated samples. PCR: polymerase chain reaction, RSV: respiratory syncytial virus, SARS-CoV-2: severe acute respiratory syndrome coronavirus 2, CSF: cerebrospinal fluid

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Table 3

- Risk of serious bacterial infections in patients with proven viral respiratory tract infection.

Characteristic	Viral RTI	SBI	P-values
Age group
0-28 days	79 (87.8)	11 (12.2)	0.034*
29-59 days	119 (95.2)	6 (4.8)
60-90 days	103 (96.3)	4 (3.7)
Gender
Male	162 (90.5)	17 (9.5)	0.016*
Female	139 (97.2)	4 (2.8)	0.016*
Previously healthy
Yes	240 (96.0)	10 (4.0)	0.002*
No	60 (84.5)	11 (15.5)	0.002*
Febrile
No	74 (97.4)	2 (2.6)	0.083
Yes	227 (92.3)	19 (7.7)	0.083
Hypoactivity
No	207 (93.7)	14 (6.3)	0.841
Yes	94 (93.1)	7 (6.9)	0.841
Blood WBC
5000-15000	221 (93.2)	16 (6.8)	0.781
<5000 or >15000	80 (94.1)	5 (5.9)	0.781
Urinalysis/dipstick
Normal	205 (96.7)	7 (3.3)	<0.001*
Not carried out	28 (96.6)	1 (3.4)
Abnormal^†	68 (84.0)	13 (16.0)
Viruses isolated
Single	249 (94.0)	16 (6.0)	0.300
Multiple	52 (91.2)	5 (8.8)	0.300
RSV
Negative	154 (93.9)	10 (6.1)	0.753
Positive	147 (93.0)	11 (7.0)	0.753
Rhinovirus/enterovirus
Negative	159 (94.1)	10 (5.9)	0.644
Positive	142 (92.8)	11 (7.2)	0.644

Values are presented as a number and percentage (%). P-values were calculated using the Pearson’s Chi-square test or Fisher’s exact test. *Significant p-value at <0.05). ^†With positive nitrites, leukocyte esterase, or ≥5 WBC/hpf. RTI: respiratory tract infection, SBI: serious bacterial infection, WBC: white blood cells, RSV: respiratory syncytial virus

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Table 4

- Predictors of serious bacterial infections in patients with proven viral respiratory tract infection.

Characteristics	P-value	OR	95% CI
Characteristics	P-value	OR	Lower	Upper
Age group
0-28 days	0.017	4.66	1.32	16.47
29-59 days	0.656	1.36	0.35	5.28
60-90 days*		1.00
Gender
Male	0.038	3.49	1.07	11.38
Female*		1.00
Previously healthy
Yes	0.003	0.23	0.09	0.61
No*		1.00
Urinalysis
Abnormal	0.007	4.12	1.48	11.42
Not carried out	0.957	1.06	0.12	9.27
Normal*		1.00