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Nathan Kuppermann, MD, MPH; David E. Bank, MD; Edward A. Walton, MD; Melvin O. Senac, Jr, MD; Ian McCaslin, MD

Arch Pediatr Adolesc Med. 1997;151(12):1207-1214.

Abstract
Objective
To compare the risks for bacteremia and urinary tract infections (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. Patients were divided into groups, based on the presence (n=163, bronchiolitis group) or absence (n=269, control group) of wheezing and/or retractions on examination. Blood cultures were obtained from all patients, and urine cultures were obtained from female patients, and male patients aged 6 months or younger. Chest radiographs were obtained on patients with lower respiratory tract signs, and those with lobar pneumonias 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 10⁴ colony-forming units per milliliter or more from the urine.

Results
None of the 156 patients with bronchiolitis had bacteremia (95% confidence interval, 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 not enough of these younger patients to make statistically conclusive comparisons.

Conclusions
Previously healthy febrile children aged 24 months or younger with bronchiolitis are unlikely to have bacteremia or UTI. Therefore, routine cultures of the blood and urine in these patients are unnecessary. More data are needed regarding the subset of febrile infants aged 2 months or younger with bronchiolitis.

Arch Pediatr Adolesc Med. 1997;151:1207-1214

Footnotes
The affiliations of the authors appear in the acknowledgment section at the end of the article.

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