#64 Common Admission Diagnoses for Children Hospitalized with Respiratory Syncytial Virus and Antibiotic Administration Practices in Amman, Jordan

Abstract

Abstract Background Determining the etiologic pathogen for acute respiratory infections is challenging, especially in low- and middle-income countries, where diagnostic testing is limited. These barriers may contribute to antibiotic overuse for viral infections. We aimed to evaluate the antibiotic administration patterns among hospitalized children with a research positive test for respiratory syncytial virus (RSV). Method Children admitted to a government-run hospital in Amman, Jordan with acute respiratory symptoms and/or fever from January 8 to March 17, 2020, were eligible for enrollment. Trained personnel conducted interviews and chart abstractions using a standardized data collection form. Nasal and/or throat swabs were collected and tested for RSV by PCR. Differences between the three most common admission diagnoses for RSV-positive children [bronchiolitis, bronchopneumonia (BP), and pneumonia] were evaluated. Results A total of 531 children were enrolled and tested and 401 (76%) were RSV-positive, of which 96% received an antibiotic and 25%, 26%, and 32% had an admission diagnosis of bronchiolitis, BP, or pneumonia, respectively. Compared to bronchiolitis and BP, RSV-positive children with a pneumonia were younger and more likely to require supplemental oxygen, receive an antibiotic during hospitalization, be admitted to the ICU; but were less likely to present with wheezing and to report antibiotic use prior to hospitalization (Table 1). RSV-positive children with BP were more likely to present with fever and have a higher C-reactive protein compared to the other diagnoses, whereas bronchiolitis was less likely to be administered antibiotics overall, but more likely to be given a macrolide. Conclusion Our results suggest that clinical presentation alone is insufficient in correctly determining causative pathogens that warrant empiric antibiotics. Thus, evaluating the role of point-of-care diagnostic testing in resource-limited settings is important and may help limit antibiotic use.