Abstract
BackgroundViral bronchiolitis is the most common cause of respiratory failure requiring invasive ventilation in young children. Bacterial co-infections may complicate and prolong paediatric intensive care unit (PICU) stay. Data on prevalence, type of pathogens and its association with disease severity are limited though. These data are especially important as bacterial co-infections may be treated using antibiotics and could reduce disease severity and duration of PICU stay. We investigated prevalence of bacterial co-infection and its association with disease severity and PICU stay.MethodsRetrospective cohort study of the prevalence and type of bacterial co-infections in ventilated children performed in a 14-bed tertiary care PICU in The Netherlands. Children less than 2 years of age admitted between December 2006 and November 2014 with a diagnosis of bronchiolitis and requiring invasive mechanical ventilation were included. Tracheal aspirates (TA) and broncho-alveolar lavages (BAL) were cultured and scored based on the quantity of bacteria colony forming units (CFU) as: co-infection (TA > 10^5/BAL > 10^4 CFU), low bacterial growth (TA < 10^5/BAL < 10^4 CFU), or negative (no growth). Duration of mechanical ventilation and PICU stay were collected using medical records and compared against the presence of co-infection using univariate and multivariate analysis.ResultsOf 167 included children 63 (37.7%) had a bacterial co-infection and 67 (40.1%) low bacterial growth. Co-infections occurred within 48 h from intubation in 52 out 63 (82.5%) co-infections. H.influenza (40.0%), S.pneumoniae (27.1%), M.catarrhalis (22.4%), and S.aureus (7.1%) were the most common pathogens. PICU stay and mechanical ventilation lasted longer in children with co-infections than children with negative cultures (9.1 vs 7.7 days, p = 0.04 and 8.1vs 6.5 days, p = 0.02).ConclusionsIn this large study, bacterial co-infections occurred in more than a third of children requiring invasive ventilation for bronchiolitis and were associated with longer PICU stay and mechanical ventilation. These findings support a clinical trial of antibiotics to test whether antibiotics can reduce duration of PICU stay.
Highlights
Viral bronchiolitis is the most common cause of respiratory failure requiring invasive ventilation in young children
This is of particular interest as current treatment strategies for severe bronchiolitis are only supportive, whereas bacterial coinfections can be treated with antibiotics and could reduce morbidity
Data on antibiotic use prior to paediatric intensive care unit (PICU) referral was available in 101 children, 51 of these received antibiotics (50.5%)
Summary
Viral bronchiolitis is the most common cause of respiratory failure requiring invasive ventilation in young children. Type of pathogens and its association with disease severity are limited though These data are especially important as bacterial co-infections may be treated using antibiotics and could reduce disease severity and duration of PICU stay. Bronchiolitis is a common respiratory condition in young children associated with a high morbidity It is caused by viral infections, Respiratory Syncytial virus (RSV) being the commonest cause in hospitalized children [1]. Previous studies suggested that bacterial co-infections may be associated with a more severe course, though definitive evidence is lacking [5,6,7,8] This is of particular interest as current treatment strategies for severe bronchiolitis are only supportive, whereas bacterial coinfections can be treated with antibiotics and could reduce morbidity
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