RISKS FOR BACTEREMIA AND URINARY-TRACT INFECTIONS IN YOUNG FEBRILE CHILDREN WITH BRONCHIOLITIS

Objective: To compare the risks for bacteremia and urinary tract infec tions (UTI) in young febrile children with and without bronchiolitis. Design: A prospective cohort study. Setting: The emergency departments of 3 pediatric referral hospitals. Patients: A convenience sample of 432 previously healthy febrile patients aged 24 months or younger. Pat ients were divided into groups, based on the presence (n=163, bronchio litis group) or absence (n=269, control group) of wheezing and/or retr actions on examination. Blood cultures were obtained from all patients , and urine cultures were obtained from female patients, and male pati ents aged 6 months or younger. Chest radiographs were obtained on pati ents with lower respiratory tract signs, and those with lobar pneumoni as were excluded (7 wheezing and 8 nonwheezing patients), leaving 156 patients with bronchiolitis and 261 control patients. Outcome Measures : Growth of any bacterial pathogens from the blood or 10(4) colony-for ming units per milliliter or more from the urine. Results: None of the 156 patients with bronchiolitis had bacteremia (95% confidence interv al, 0%-1.9%) vs 2.7% of the 261 controls (95% confidence interval, 1.1 %-5.4%; P=.049); 1.9% of the patients with bronchiolitis had UTI vs 13 .6% of the controls (odds ratio, 0.12; 95% confidence interval, 0.02-0 .55; P=.001). None of the subset of patients with bronchiolitis aged 2 months or younger (n=36) had bacteremia or UTI; however, there were n ot enough of these younger patients to make statistically conclusive c omparisons. Conclusions: Previously healthy febrile children aged 24 m onths or younger with bronchiolitis are unlikely to have bacteremia or UTI. Therefore, routine cultures of the blood and urine in these pati ents are unnecessary. More data are needed regarding the subset of feb rile infants aged 2 months or younger with bronchiolitis.