Febrile infants with bronchiolitis treated in primary care settings received a full sepsis evaluation one-half as often as other febrile infants and seemed to have even lower rates of serious bacterial illness, compared with infants treated in emergency departments and hospitals, results from a study of more than 3,000 cases show.
Those are key findings from the first large-scale study to examine primary care treatment and associated bacterial infections among febrile infants with clinically diagnosed bronchiolitis.
Although most existing studies in the medical literature have shown that the rates of serious bacterial illness in children evaluated in emergency departments or hospitalized with fever and bronchiolitis or respiratory syncytial virus (RSV) range from 0% to 10%, “No studies of the office-based care of febrile infants with clinically diagnosed bronchiolitis have been published, leaving primary care practitioners without generalizable guidelines for management,” researchers led by Dr. Lynn M. Luginbuhl of the department of pediatrics at Harvard Medical School, Boston, reported.
In a report from the Pediatric Research in Office Settings (PROS) network, a research program of the American Academy of Pediatrics, Dr. Luginbuhl and her associates prospectively studied 3,066 febrile infants in 219 practices in 44 states who were evaluated between Feb. 28, 1995, and April 25, 1998 (Pediatrics 2008;122:947-54).
Infants were eligible for the trial if they had had a temperature of 38° C or higher in the office or in the preceding 24 hours at home and were previously healthy, without major comorbidity.
They compared the frequency of sepsis evaluation, parenteral antibiotic treatment, and serious bacterial illness in infants with and without clinically diagnosed bronchiolitis, which was defined in the study manual as “an infection of the bronchioles characterized by wheezing, tachypnea, fever, and cough, and is usually associated with respiratory viruses, in particular RSV. Conclusive diagnosis includes isolation of RSV from nasopharyngeal washings or positive RSV antigen. Parainfluenza A and B are also common causes.”
The researchers then used logistic regression to identify predictors of sepsis evaluation and parenteral antibiotic treatment.
Clinicians made a clinical diagnosis of bronchiolitis in 218 of the 3,066 (7%) infants.
Compared with infants without a diagnosis of bronchiolitis, those with the diagnosis were significantly older (a mean of 8 weeks vs. 7 weeks, respectively) and were significantly less likely to undergo a complete sepsis evaluation (14% vs. 28%, respectively); urine testing (33% vs. 54%); cerebrospinal culture (16% vs. 32%); and to receive parenteral antibiotic treatment (33% vs. 45%).
There were no serious bacterial illnesses (SBIs) among infants with a diagnosis of bronchiolitis. SBIs among the infants without a diagnosis of the condition included 167 (5%) cases of urinary tract infection, 49 (2%) cases of bacteremia, and 14 (less than 1%) cases of meningitis.
Dr. Luginbuhl and her associates had no relevant conflicts to disclose.