Common Lower Respiratory Infection Research Articles

A Retrospective Study on Effectiveness of Antimonium Tartaricum 200 for Respiratory Complaints in Paediatric Age Group

Common upper respiratory tract infections in children are Nasopharyngitis (common cold), Acute tonsillopharyngitis (sore throat) and common lower respiratory tract infections epiglottitis, laryngitis, larygotracheo bronchitis, spasmodic laryngitis, Pneumonia, Bronchiolitis, Bronchial asthma etc. Aim: The study’s objectives are to highlight the incidence of respiratory in kids and identify the effectiveness of Antimonium tartaricum 200 for respiratory complaints in paediatric age group.

Epidemiological shifts in bronchiolitis patterns and impact of the COVID-19: A two-season comparative study.

Bronchiolitis is a common lower respiratory tract infection (LRTI) affecting infants and young children. Respiratory syncytial virus (RSV) has historically been the primary causative agent, but other viruses also contribute to the LRTI epidemiology. Recent changes in epidemiology and clinical patterns due to the coronavirus disease 2019 (COVID-19) pandemic have raised concerns. This study aims to analyze the impact of the pandemic on bronchiolitis epidemiology and severity. Two consecutive bronchiolitis seasons (October 2021 to March 2022 and October 2022 to March 2023) were compared. Data on viral agents, hospitalization duration, clinical severity, and respiratory support requirements were collected from pediatric patients at San Marco Hospital, University of Catania. In the 2021-2022 season, RSV was the predominant virus (40%), followed by other viruses, with mild clinical outcomes. In the 2022-2023 season, RSV remained prevalent (58.7%), but other viruses, including rhinovirus (RV) and influenza, showed a significant increase (p < .05) in bronchiolitis cases and severity. Notably, RSV-related bronchiolitis did not exhibit greater severity compared to non-RSV cases in the 2022-2023 season, contrary to the previous year. The COVID-19 pandemic appears to have shifted the epidemiological landscape of bronchiolitis, with a peak incidence in November instead of January/February. Non-RSV viruses (RV, influenza A and B, as well as metapneumovirus) have gained prominence, possibly due to viral competition and reduced pandemic-related restrictions. Traditionally, RSV has been the primary pathogen responsible for most bronchiolitis cases. Nonetheless, the findings of this study indicate a shifting landscape in bronchiolitis etiology, with RSV gradually diminishing in its role. Contrary to the previous year, RSV-related bronchiolitis did not exhibit greater severity compared to non-RSV cases in the 2022-2023 season.

Antibiotic Use in Korean Children Diagnosed With Acute Bronchiolitis: Analysis of the National Health Insurance Reimbursement Data.

Acute bronchiolitis, the most common lower respiratory tract infection in infants, is mostly caused by respiratory viruses. However, antibiotics are prescribed to about 25% of children with acute bronchiolitis. This inappropriate use of antibiotics for viral infections induces antibiotic resistance. This study aimed to determine the antibiotic prescription rate and the factors associated with antibiotic use in children with acute bronchiolitis in Korea, where antibiotic use and resistance rates are high. Healthcare data of children aged < 24 months who were diagnosed with acute bronchiolitis between 2016 and 2019 were acquired from the National Health Insurance system reimbursement claims data. Antibiotic prescription rates and associated factors were evaluated. A total of 3,638,424 visits were analyzed. The antibiotic prescription rate was 51.8%, which decreased over time (P < 0.001). In the multivariate analysis, toddlers (vs. infants), non-capital areas (vs. capital areas), primary clinics and non-tertiary hospitals (vs. tertiary hospitals), inpatients (vs. outpatients), and non-pediatricians (vs. pediatricians) showed a significant association with antibiotic prescription (P < 0.001). Fourteen cities and provinces in the non-capital area exhibited a wide range of antibiotic prescription rates ranging from 41.2% to 65.4%, and five (35.7%) of them showed lower antibiotic prescription rates than that of the capital area. In Korea, the high antibiotic prescription rates for acute bronchiolitis varied by patient age, region, medical facility type, clinical setting, and physician specialty. These factors should be considered when establishing strategies to promote appropriate antibiotic use.

Nurses' Perception Toward Therapeutic Strategies for Children with Pneumonia

Background: Pneumonia is the common lower respiratory tract infection among pediatrics, especially under five; it is a common cause of under-five children morbidity and mortality. Objectives of study: To identify nurses' perceptions toward therapeutic strategies for children with pneumonia and to find the association between their perceptions and their demographic variables. Methods: A Convenient sample of 46 nurses in Baghdad city from three hospitals) Kadhimiya Hospital for Children, Central Teaching Hospital of Pediatrics, and Child Welfare Teaching Hospital) included in the study to identify their perceptions regarding pneumonia in children. Results: The results of the study present that most of the nurses' participants in the age group (20-25 years) are female, with a diploma in nursing. There is an association between nurses' perceptions with many variables such as age, education level, service in the ward, and training courses. Conclusions: In general, nurses were well aware of the strategies used for children with pneumonia, but gaps in some items are likely due to their information taken from social media. Activating the Ministry of Health's media on the importance of global strategies for treating children with pneumonia is an important step to improve nurses' perception gaps.

Clinical analysis of 114 cases of bronchiolitis in infants.

Bronchiolitis is a common lower respiratory tract infection in infants and young children. Severe cases may be accompanied by obvious dyspnea and oxygen saturation decline. To summarize the clinical features, standard diagnosis, and treatment of bronchiolitis. This is a retrospective analysis of 114 pediatric patients (74 males, 40 females) who were first diagnosed as having bronchioles at the Department of Pediatrics of Tongling Maternal and Child Health Hospital from January 2019 to December 2019. The clinical features, imaging features, treatment, and other clinical data were recorded and analyzed. The age of onset of the disease was mainly from 1 mo to 6 mo (75.4%), and the time to hospital visit was mostly from the 2nd day to the 4th day of the course of the disease (75.4%). Lung imaging examination showed increase in lung texture, fuzzy (93.8%). The main treatment was atomization therapy: Budesonide combined with terbutaline (45.6%) and budesonide combined with salbutamol (38.5%). The average hospitalization time was 7.1 ± 2.4 d, and the overall cure rate was 94.7%. In patients without bacterial infection, the use of antibiotics significantly prolonged the length of hospital stay (7.8 ± 2.5 d vs 5.7 ± 1.8 d) and improved the cure rate (98.3% vs 87.9%, P < 0.05). Infants with bronchiolitis are mainly male and tend to have a good prognosis. However, the unneeded use of antibiotics may prolong the length of hospital stay significantly, which imposes the burden both on the patients and hospital system.

Association of outcomes in point-of-care lung ultrasound for bronchiolitis in the pediatric emergency department

BackgroundAcute bronchiolitis (AB) is the most common lower respiratory tract infection in infants. Objective scoring tools and plain film radiography have limited application, thus diagnosis is clinical. The role of point-of-care lung ultrasound (LUS) is not well established. ObjectiveWe sought to characterize LUS findings in infants presenting to the pediatric ED diagnosed with AB, and to identify associations between LUS and respiratory support (RS) at 12 and 24 h, maximum RS during hospitalization, disposition, and hospital length of stay (LOS). MethodsInfants ≤12 months presenting to the ED and diagnosed with AB were enrolled. LUS was performed at the bedside by a physician. Lungs were divided into 12 segments and scanned, then scored and summated (min. 0, max. 36) in real time accordingly:0 - A lines with <3 B lines per lung segment.1 - ≥3 B lines per lung segment, but not consolidated.2 - consolidated B lines, but no subpleural consolidation.3 - subpleural consolidation with any findings scoring 1 or 2.Chart review was performed for all patients after discharge. RS was categorized accordingly: RS (room air), low RS (wall O2 or heated high flow nasal cannula <1 L/kg), and high RS (heated high flow nasal cannula ≥1 L/kg or positive pressure). Results82 subjects were enrolled. Regarding disposition, the mean (SD) LUS scores were: discharged 1.18 (1.33); admitted to the floor 4.34 (3.62); and admitted to the ICU was 10.84 (6.54). For RS, the mean (SD) LUS scores at 12 h were: no RS 1.56 (1.93), low RS 4.34 (3.51), and high RS 11.94 (6.17). At 24 h: no RS 2.11 (2.35), low RS 4.91 (3.86), and high RS 12.64 (6.48). Maximum RS: no RS 1.22 (1.31), low RS 4.11 (3.61), and high RS 10.45 (6.16). Mean differences for all dispositions and RS time points were statistically significant (p < 0.05, CI >95%). The mean (SD) hospital LOS was 84.5 h (SD 62.9). The Pearson correlation coefficient (r) comparing LOS and LUS was 0.489 (p < 0.0001). ConclusionHigher LUS scores for AB were associated with increased respiratory support, longer LOS, and more acute disposition. The use of bedside LUS in the ED may assist the clinician in the management and disposition of patient's diagnosed with AB.

Joint modeling of longitudinal changes of pulse rate and body temperature with time to recovery of pneumonia patients under treatment: a prospective cohort study

BackgroundPneumonia is the leading infectious cause of mortality worldwide and one of the most common lower respiratory tract infections that is contributing significantly to the burden of antibiotic consumption. The study aims to identify the determinants of the progress of pulse rate, body temperature and time to recovery of pneumonia patients.MethodA prospective cohort study design was used from Felege Hiwot referral hospital on 214 sampled pneumonia patients from March 01, 2022 up to May 31, 2022. The Kaplan–Meier survival estimate and Log-Rank test was used to compare the survival time. Joint model of bivariate longitudinal and time to event model was used to identify factors of longitudinal change of pulse rate and body temperature with time to recovery jointly.ResultAs the follow up time of pneumonia patient’s increase by one hour the average longitudinal change of pulse rate and body temperature were decreased by 0.4236 bpm and 0.0119 {C}^{0}. The average longitudinal change of pulse rate and body temperature of patients who lived in rural was 1.4602 bpm and 0.1550 {C}^{0} times less as compared to urban residence. Patients who had dangerous signs are significantly increased the average longitudinal change of pulse rate and body temperature by 2.042 bpm and 0.6031 {C}^{0} as compared to patients who had no dangerous signs. A patient from rural residence was 1.1336 times more likely to experience the event of recovery as compared to urban residence. The estimated values of the association parameter for pulse rate and body temperature were -0.4236 bpm and -0.0119 respectively, which means pulse rate and body temperature were negatively related with patients recovery time.ConclusionPulse rate and body temperature significantly affect the time to the first recovery of pneumonia patients who are receiving treatment. Age, residence, danger sign, comorbidity, baseline symptom and visiting time were the joint determinant factors for the longitudinal change of pulse rate, body temperature and time to recovery of pneumonia patients. The joint model approach provides precise dynamic predictions, widespread information about the disease transitions, and better knowledge of disease etiology.

Epigenome-wide association analysis of infant bronchiolitis severity: a multicenter prospective cohort study

Bronchiolitis is the most common lower respiratory infection in infants, yet its pathobiology remains unclear. Here we present blood DNA methylation data from 625 infants hospitalized with bronchiolitis in a 17-center prospective study, and associate them with disease severity. We investigate differentially methylated CpGs (DMCs) for disease severity. We characterize the DMCs based on their association with cell and tissues types, biological pathways, and gene expression. Lastly, we also examine the relationships of severity-related DMCs with respiratory and immune traits in independent cohorts. We identify 33 DMCs associated with severity. These DMCs are differentially methylated in blood immune cells. These DMCs are also significantly enriched in multiple tissues (e.g., lung) and cells (e.g., small airway epithelial cells), and biological pathways (e.g., interleukin-1-mediated signaling). Additionally, these DMCs are associated with respiratory and immune traits (e.g., asthma, lung function, IgE levels). Our study suggests the role of DNA methylation in bronchiolitis severity.

Viral and bacterial lung infections in children: algorithms for diagnosis and therapy. A review

Community-acquired pneumonia is among the most common lower respiratory infections. The main etiological factors of lower respiratory infections are bacteria, viruses, and combinations. Pediatricians are increasingly faced with the problem of treating patients with infections caused by multidrug-resistant bacteria and viral lung infections; therefore, differential diagnosis of viral and bacterial lung infections in children is relevant. Significant progress has been made in diagnosing, treating, and preventing pneumonia in children; however, some issues require improvement in approaches to the differential diagnosis of lung infections in children. The paper aims to familiarize healthcare providers with modern principles of differential diagnosis and treatment of lung infections in children.

Assessing the burden of bronchiolitis and lower respiratory tract infections in children ≤24 months of age in Italy, 2012-2019.

Bronchiolitis is the most common lower respiratory tract infection (LRTI) in children and is mainly caused by the Respiratory Syncytial Virus (RSV). Bronchiolitis presents seasonally and lasts about five months, usually between October to March, with peaks of hospitalizations between December and February, in the Northern Hemisphere. The burden of bronchiolitis and RSV in primary care is not well understood. This retrospective analysis used data from Pedianet, a comprehensive paediatric primary care database of 161 family paediatricians in Italy. We evaluated the incidence rates (IR) of all-cause bronchiolitis (ICD9-CM codes 466.1, 466.11 or 466.19), all-cause LRTIs, RSV-bronchiolitis and RSV-LRTIs in children from 0 to 24 months of age, between January 2012 to December 2019. The role of prematurity (<37 weeks of gestational age) as a bronchiolitis risk factor was evaluated and expressed as odds ratio. Of the 108,960 children included in the study cohort, 7,956 episodes of bronchiolitis and 37,827 episodes of LRTIs were recorded for an IR of 47 and 221 × 1,000 person-years, respectively. IRs did not vary significantly throughout the eight years of RSV seasons considered, showing a seasonality usually lasting five months, between October and March, while the peak of incidence was between December and February. Bronchiolitis and LRTI IRs were higher during the RSV season, between October and March, regardless of the month of birth, with bronchiolitis IR being higher in children aged ≤12 months. Only 2.3% of bronchiolitis and LRTI were coded as RSV-related. Prematurity and comorbidity increased the risk of bronchiolitis; however, 92% of cases happened in children born at term, and 97% happened in children with no comorbidities or otherwise healthy. Our results confirm that all children aged ≤24 months are at risk of bronchiolitis and LRTI during the RSV season, regardless of the month of birth, gestational age or underlying health conditions. The IRs of bronchiolitis and LRTI RSV-related are underestimated due to the poor outpatient epidemiological and virological surveillance. Strengthening the surveillance system at the paediatric outpatient level, as well as at the inpatient level, is needed to unveil the actual burden of RSV-bronchiolitis and RSV-LRTI, as well as to evaluate the effectiveness of new preventive strategies for anti-RSV.

Prevalence of new-onset atrial fibrillation in hospitalized patients with community-acquired pneumonia: a systematic review and meta-analysis.

Community-acquired pneumonia (CAP) is a common lower respiratory tract infection, often complicated by cardiovascular events, including cardiac arrhythmias. New-onset atrial fibrillation (newAF) has been associated with increased mortality in CAP patients, especially in those critically ill; however, limited data on the prevalence of newAF in patients with CAP are available. We aim to estimate the pooled prevalence of newAF and its impact on adverse outcomes in patients with CAP, through a systematic review and meta-analysis. MEDLINE and EMBASE were systematically searched from inception to 27 January 2022. All studies reporting the prevalence of newAF in CAP patients were included and all-cause mortality was extracted when available. The pooled prevalence of newAF, 95% Confidence Intervals (CI), and 95% Prediction Intervals (PI) were computed. The inconsistency index (I2) was calculated to measure heterogeneity. Subgroup analyses were also performed. A protocol for this study was registered on PROSPERO (CRD42022307422). Among 7,655 records retrieved, 10 studies were included, with a total of 280,589 CAP patients. Pooled prevalence of newAF in CAP patients was 7.6% (95% CI 6.4-9.0%, 95% PI 4.3-13.1%, I2 = 95%). Subgroup analyses showed no significant differences according to geographical location or study design. Patients with newAF had a higher risk of mortality among the studies included in the systematic review. NewAF is a common complication, occurring in 7.6% of CAP patients, with prediction intervals suggesting an even higher burden. CAP patients who develop newAF during hospitalization may be at higher risk of mortality in both short- and long-term follow-up.

Respiratory tract infections and risk factors for infection in a cohort of 330 patients with axial spondyloarthritis or psoriatic arthritis.

Respiratory tract infections (RTIs) are the most common infections in patients with rheumatic diseases under immunosuppressive treatment and may contribute to morbidity and mortality as well as increased healthcare costs. However, to date only limited data on infection risk in spondyloarthritis (SpA) patients are available. In this study we assessed the occurrence of respiratory tract infections in a monocentric real-world cohort consisting of 330 patients (168 psoriatic arthritis and 162 axial spondyloarthritis patients) and determined factors associated with increased infection risk. Out of 330 SpA patients, 89.3% had suffered from ≥ 1 upper respiratory tract infection (URTI) and 31.1% from ≥ 1 lower respiratory tract infection (LRTI) within the last two years. The most common URTIs were rhinitis and laryngitis/pharyngitis with 87.3% and 36.1%, respectively. Bronchitis constituted the most common LRTI, reported in 29.7% of patients. In a multivariate binomial logistic regression model occurrence of LRTI was associated with chronic lung disease (OR 17.44, p=0.006), glucocorticoid therapy (OR 9.24, p=0.012), previous history of severe airway infections (OR 6.82, p=0.013), and number of previous biological therapies (OR 1.72, p=0.017), whereas HLA B27 positivity was negatively associated (OR 0.29, p=0.025). Female patients reported significantly more LRTIs than male patients (p=0.006) and had a higher rate of antibiotic therapy (p=0.009). There were no significant differences between axSpA and PsA patients regarding infection frequency or antibiotic use. 45.4% of patients had required antibiotics for respiratory tract infections. Antibiotic therapy was associated with smoking (OR 3.40, p=0.008), biological therapy (OR 3.38, p=0.004), sleep quality (OR 1.13, p<0.001) and age (OR 0.96, p=0.030). Hypogammaglobulinemia (IgG<7g/l) was rare (3.4%) in this SpA cohort despite continuous immunomodulatory treatment. Awareness of these risk factors will assist physicians to identify patients with an increased infection risk, who will benefit from additional preventive measures, such as vaccination and smoking cessation or adjustment of DMARD therapy.

66 Trends in bronchiolitis emergency department visits in Ontario, 2004-2018: A population-based cohort study

Abstract Background Bronchiolitis is the most common lower respiratory tract infection in children and places a significant burden on the health care system. There have been few population-based studies describing trends in emergency department (ED) rates over time. Objectives To estimate population-based rates and trends of bronchiolitis ED visits from 2004 to 2018 in Ontario, Canada. Design/Methods We conducted a population-based cohort study of all children less than 2 years of age from April 1, 2004 to March 31, 2018 using linked administrative data. Bronchiolitis hospital encounters were identified using ICD-10 discharge diagnosis codes. The primary outcome was bronchiolitis ED visit rate estimated per 1000 person-years. Secondary outcomes included ED visit rate by subgroups (age, gestational age, birth weight, comorbidity, rurality, and material deprivation), bronchiolitis hospitalizations per 100 bronchiolitis ED visits, bronchiolitis ED 14-day revisit rate (ED revisit or hospitalization per 100 ED visits), and mortality rate (in- and out-of-hospital deaths per 1000 person-years). Annual percent change (APC) was estimated using log-linear regression models to determine trends in outcomes. Results Of the 2,336,446 infants less than 2 years of age during the study period, 93,843 children (4.0%) had 115,116 bronchiolitis ED visits at 208 hospitals. Bronchiolitis accounted for an increasing percentage of all-cause ED visits, from 7,446 (3.4%) of 216,122 in 2004-2005 to 9,702 (4.2%) of 231,693 in 2017-2018 (APC 2.2%; 95% CI [1.2-3.2]). Bronchiolitis ED visits per 1000 person-years increased by 26.7% from 27.0 (95% CI, 26.4-27.7) in 2004-2005 to 34.2 (95% CI, 33.5-34.9) in 2017-18 (APC=2.6%; 95% CI [1.5-3.8], p&amp;lt;0.001). Subgroup specific rates similarly increased over the study period. Hospitalizations per 100 ED visits decreased from 51.8 (95% CI, 50.2-53.4) in 2004-2005 to 37.0 (95% CI, 35.8-38.2) in 2017-2018 (APC -2.6% [95% CI, -3.3 to -1.8], p&amp;lt;0.0001). Revisits after an ED encounter were stable, 14.0 (95% CI, 13.0-15.0) in 2004-2005 and 11.8 (95% CI, 11.1-12.6) per 100 ED visits in 2017-2018 (APC -0.3%, [95% CI, -1.3 to 0.7]; p=0.68), as was the mortality rate (Figure 1). Conclusion In a population-based study from 2004 to 2018, bronchiolitis ED use increased significantly. However, the bronchiolitis hospitalizations declined relative to ED visits, and the ED revisit and mortality rate remained stable, suggesting that illness severity did not increase. These findings indicate an increasing health services burden of bronchiolitis on EDs.

Tea consumption and risk of lower respiratory tract infections: a two-sample mendelian randomization study.

Observational studies have reported the association between tea consumption and the risk of lower respiratory tract infections (LRTIs). However, a consensus has yet to be reached, and whether the observed association is driven by confounding factors or reverse causality remains unclear. A two-sample Mendelian randomization (MR) analysis was conducted to determine whether genetically predicted tea intake is causally associated with the risk of common LRTI subtypes. Genome-wide association study (GWAS) from UK Biobank was used to identify single-nucleotide polymorphisms (SNPs) associated with an extra cup of tea intake each day. The summary statistics for acute bronchitis, acute bronchiolitis, bronchiectasis, pneumonia, and influenza and pneumonia were derived from the FinnGen project. We found that genetically predicted an extra daily cup of tea intake was causally associated with the decreased risk of bronchiectasis [odds ratio (OR) = 0.61, 95% confidence interval (CI) = 0.47-0.78, P < 0.001], pneumonia (OR = 0.90, 95% CI = 0.85-0.96, P = 0.002), influenza and pneumonia (OR = 0.91, 95% CI = 0.85-0.97, P = 0.002), but not with acute bronchitis (OR = 0.91, 95% CI = 0.82-1.01, P = 0.067) and acute bronchiolitis (OR = 0.79, 95% CI = 0.60-1.05, P = 0.100). Sensitivity analyses showed that no heterogeneity and pleiotropy could bias the results. Our findings provided new evidence that genetically predicted an extra daily cup of tea intake may causally associated with a decreased risk of bronchiectasis, pneumonia, and influenza and pneumonia.

#54 Morbidity and Mortality Associated with Respiratory Syncytial Virus (RSV) Among Pediatric Solid Organ Transplant (SOT) Recipients: Preliminary Results from a Multi-Site U.S. Study.

Abstract Background RSV is the most common lower respiratory tract infection (LRTI) among children. Serious adverse outcomes are more likely among immunocompromised patients, including progression to pneumonia, respiratory failure, and increased mortality rates. We present interim analyses results from a secondary data use multi-site study to characterize the morbidity and mortality associated with RSV infection among pediatric SOT patients. Method Pediatric (&amp;lt; 18 years old at transplant) SOT recipients from 10 U.S. transplant centers from the Pediatric Infectious Diseases Transplant Network (PIDTRAN) who underwent SOT between 2010 and 2019 and were RSV positive within 365 days of SOT were identified from medical records. Demographics, underlying condition, and clinical characteristics were abstracted and entered in an electronic REDCap survey. Descriptive statistics were used to characterize the clinical course and outcomes of RSV infection. Results In total, 40 SOT patients were eligible for analysis with 40 (93%) reporting 1 case of RSV within 365 days of transplant and 3 (7%) reported 2 episodes resulting in 43 RSV episodes. Over half (24, 60%) were male, 24 (60%) were white/Caucasian, with a median age of 2 years at the time of RSV diagnosis. The majority received 1 SOT (80%) prior to RSV diagnosis. The most common transplanted organ was liver 17 (42%) followed by heart 14 (36%) and kidney 9 (22%). Among the 43 episodes reported, almost half (46.5%) were diagnosed with LRTI at the time of RSV diagnosis and 29 (67.4%) required hospitalization. Among the 43 episodes, none received palivizumab and 1 (2.3%) received IVIG in the 4 weeks prior to RSV diagnosis. Nearly half (21, 48.8%) received oxygen support at least 4 hours per day (at least one day) with 3 (15%) requiring ventilator support. Only 2 (5%) were treated with ribavirin while 3 (7%) received IVIG within 28 days for the treatment of RSV. None received palivizumab within 28 days of diagnosis for RSV treatment. Among those who initially presented with upper respiratory tract infection, 2 (10%) progressed to LRTI after initial diagnosis of a URTI. One (2.4%) death related to RSV was reported. Conclusion Preliminary results from this continuing multi-site study demonstrate RSV is an ongoing concern among SOT recipients with approximately half developing LRTI and two thirds requiring hospitalization. These data help our understanding of RSV infections in this population and inform future prospective study designs to better define RSV risk as well as help address optimal prophylaxis and treatment strategies for SOT recipients at risk for severe illness.

#53 Morbidity and Mortality Associated with Respiratory Syncytial Virus (RSV) Among Pediatric Hematopoietic Cell (HCT) Recipients: Preliminary Results from a Multi-Site U.S. Study.

Abstract Background RSV is the most common lower respiratory tract infection (LRTI) among children. Serious adverse outcomes are more likely among immunocompromised patients, including progression to pneumonia, respiratory failure, and increased mortality rates. We present interim analysis results from a multi-site study to characterize morbidity and mortality associated with RSV infection among pediatric HCT patients. Method Pediatric (&amp;lt; 18 years old at transplant) HCT recipients from 10 U.S. transplant centers part of the Pediatric Infectious Diseases Transplant Network (PIDTRAN) who underwent HCT between 2010 and 2019 and were RSV positive during pre-transplant conditioning or within 365 days of HCT were identified from medical records. Demographics, underlying condition, and clinical characteristics were abstracted and entered in an electronic REDCap survey. Descriptive statistics were used to characterize the clinical course and outcomes of RSV infection. Results In total, 108 HCT patients were eligible with 108 (96%) reporting 1 case of RSV within 365 days of transplant and 5 (4%) reported 2 episodes resulting in 113 RSV episodes included in the analysis. Approximately half (53.7%) were male, 53 (49.1%) were white/Caucasian, with a median age of 7 years at the time of RSV diagnosis. The majority only received 1 HCT (84%) prior to RSV diagnosis. The most common HCT was allogeneic type (77.8%), 63 (59%) received myeloablative conditioning, and 23 (22.3%) were t-cell depleted. Just over one third (38%) had received systemic steroids in the 2 weeks prior to RSV diagnosis. Among the 113 episodes, 3 (2.7%) received palivizumab and 34 (30%) received IVIG in the 4 weeks prior to RSV diagnosis. One fourth (25.6%) were hospitalized due to RSV and 13 (11.5%) were diagnosed with LRTI at presentation and 3 (2.7%) progressed to LRTI after initial diagnosis of a URTI. Fifteen (13.3%) received at least 4 hours of oxygen support each day (at least one day), including 2 (13.3%) requiring mechanical ventilation. A quarter (24.8%) were treated with ribavirin, 10 (9%) received IVIG, and 15 (13.4%) received palivizumab for treatment of RSV. Seven (6.3%) deaths related to RSV were reported. Conclusion Preliminary results from this continuing multi-site study demonstrate RSV is an ongoing concern among HCT recipients with 1 in 10 developing LRTI and a quarter requiring hospitalization. These data help our understanding of RSV infections in this population and inform future prospective study designs to better define RSV risk as well as help address optimal prophylaxis and treatment strategies for HCT recipients at risk for severe illness.

Modifiable environmental factors predispose term infants to bronchiolitis but bronchiolitis itself predisposes to respiratory sequelae

Viral bronchiolitis is a common lower respiratory tract infection in infants. Environmental and genetic factors can favor respiratory tract infections. The aim of this study is to analyze risk factors for bronchiolitis and to investigate the predisposing factors for developing transient wheezing and asthma through a 6-year follow-up after hospitalizationfor bronchiolitis compared with a group of healthy controls that belonged to Piccolipiù cohort,who never had bronchiolitis. We enrolled 645 infants hospitalized with bronchiolitis. A structured questionnaire was used to obtain demographic and clinical data. At 6 years of age, 370 cases and 183 controls were investigated for the presence of asthma by the structured questionnaire, for prick test and for spirometry, and were classified to asthmatic, transient wheezing, and no wheezing/no asthma. Breastfeeding was an independent protective factor (odds ratio [OR]: 0.3, 95% confidence interval [95% CI]:0.2-0.4, p < 0.001) and tobacco smoke was a risk factor for the development of bronchiolitis (OR: 2.1, 95% CI: 1.4-3.1, p < 0.001). Analyzing follow-up, bronchiolitis increased the risk of developing transient wheezing by 12.9 (95% CI: 6.3-26.1, p < 0.001) and of developing asthmaby 4.6 (95% CI: 1.9-10.7, p < 0.001). A positive family history of atopy increased the risk of developing asthma by 3.1 (95% CI: 1.4-6.7, p = 0.005). Asthmatic patients had a lower % FEV1, a lower % flow-volume curve (FVC), and a lower FEV1/FVC value, and they had more frequently positive skin prick test. Bronchiolitis is influenced by environmental factors: tobacco smoke increases its risk and breastfeeding is a protective factor. At the end of 6 years of follow-up, bronchiolitis is a significant risk factor to have pre-school wheezing and asthma.

Pediatric lower respiratory tract infection: Considerations for the anesthesiologist.

Neonatal and childhood infectious diseases continue to be a global health problem. Acute respiratory tract infections are typically classified as upper respiratory tract infection and lower respiratory tract infections. The most common lower respiratory infections in childhood are pneumonia and bronchiolitis. Vaccination against measles, diphtheria, pertussis, Haemophilus influenzae, pneumococcus, and influenza resulted in a significant reduction in the incidence of acute respiratory tract infection globally. Though the global burden of the disease has decreased, the mortality rates still are higher in developing countries. Patients with severe lower respiratory tract infections and their complications are often evaluated for elective or emergency procedures. In this review article, the authors aim to discuss the etiology, pathogenesis, preoperative evaluation of lower respiratory tract infections, and the anesthesia implications pertinent to the practice of anesthesia.

Impact of Guidelines Publication on Acute Bronchiolitis Management: 10-Year Experience from a Tertiary Care Center in Italy.

Bronchiolitis is the most common lower respiratory tract infection in infants. According to evidence-based guidelines, diagnosis is clinical, there is no need for routine use of laboratory or instrumental tests and therapy is primarily supportive, based on oxygen and adequate fluid supplementation. Nevertheless, unnecessary diagnostic tests and pharmacological treatments are still very common. The aim of this retrospective cohort study was to evaluate how the management of bronchiolitis has changed in the last ten years in a Tertiary Care Center in Italy, assessing adherence to national guidelines. Considering the publication of the Italian inter-society consensus document in 2014, we compared patients admitted in the prior four epidemic seasons with patients admitted in the latter six epidemic seasons. The comparison between the two groups showed a significant reduction in the prescription of systemic corticosteroids (58.9% vs. 41.8%, p < 0.001), nebulized epinephrine (73.8% vs. 38.3%, p < 0.001) and antibiotics (59.5% vs. 42.3%, p < 0.001), together with a drastic decrease in the use of chest X-ray (92.2% vs. 54.4%, p < 0.001). On the contrary, the use of inhaled salbutamol remained substantially stable over time (39.4% vs. 37.6%, p = 0.505). Despite the encouraging results, further efforts are needed to limit the prescription of ineffective therapies like antibiotics and inhaled salbutamol.

Prospective Evaluation of a Rapid Clinical Metagenomics Test for Bacterial Pneumonia.

BackgroundThe diagnosis of bacterial pathogens in lower respiratory tract infections (LRI) using conventional culture methods remains challenging and time-consuming.ObjectivesTo evaluate the clinical performance of a rapid nanopore-sequencing based metagenomics test for diagnosis of bacterial pathogens in common LRIs through a large-scale prospective study.MethodsWe enrolled 292 hospitalized patients suspected to have LRIs between November 2018 and June 2019 in a single-center, prospective cohort study. Rapid clinical metagenomics test was performed on-site, and the results were compared with those of routine microbiology tests.Results171 bronchoalveolar lavage fluid (BAL) and 121 sputum samples were collected from patients with six kinds of LRIs. The turnaround time (from sample registration to result) for the rapid metagenomics test was 6.4 ± 1.4 hours, compared to 94.8 ± 34.9 hours for routine culture. Compared with culture and real-time PCR validation tests, rapid metagenomics achieved 96.6% sensitivity and 88.0% specificity and identified pathogens in 63 out of 161 (39.1%) culture-negative samples. Correlation between enriched anaerobes and lung abscess was observed by Gene Set Enrichment Analysis. Moreover, 38 anaerobic species failed in culture was identified by metagenomics sequencing. The hypothetical impact of metagenomics test proposed antibiotic de-escalation in 34 patients compared to 1 using routine culture.ConclusionsRapid clinical metagenomics test improved pathogen detection yield in the diagnosis of LRI. Empirical antimicrobial therapy could be de-escalated if rapid metagenomics test results were hypothetically applied to clinical management.