Abstract
Objective: Concomitant bacterial pneumonia (CBP)in children with respiratory syncytial virus (RSV)bronchiolitis is considered to be low and the use ofantibiotics is generally discouraged. Our experiencehowever suggested that this incidence is higher inchildren with RSV and acute lung injury (ALI). Ourobjective was to determine the incidence of CBP inchildren mechanically ventilated for RSV and ALI.Methods: We conducted a retrospective chartreview of all patients with RSV and ALI requiringmechanical ventilation and admitted to the PICU ofa tertiary care medical center from 2004 - 2009. Allpatients were identified in the PICU database andwere screened for ALI. Composite diagnosis of CBPwas made using 4 criteria: 1) Trachea aspirate cultures at/near the time ofintubation, 2) Chest radiograph, 3) Blood culture, 4) WBC abnormality. Results: A total of 95 patients were included. Fiftyfive(57.9%) were diagnosed as having CBP; 26(27.4%) met two criteria (possible CBP) and 29(30.5%) > 2 criteria (probable CPB). In infants withCBP a lower oxygenation index, a longer length ofstay and less ventilator free days were observed. All children with CBP and 97% of patients withoutCPB received antibiotics.Conclusion: A high incidence of CBP was observedin children with RSV and ALI requiring mechanicalventilation. The use of empiric antibiotics for pendingculture results may be justified in this specific patientgroup.
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