Concurrent bacterial infection and prolonged mechanical ventilation in infants with respiratory syncytial virus lower respiratory tract disease

• Published in: Intensive care medicine 2005-05, Vol.31 (5), p.680-685
• Main Authors: KNEYBER, Martin C. J, VAN OUD-ALBLAS, Heleen Blussé, VAN VLIET, Margreet, UITERWAAL, Cuno S. P. M, KIMPEN, Jan L. L, VAN VUGHT, Adrianus J
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Bacterial Agents - therapeutic use; Antibiotics; Bacteremia - epidemiology; Bacterial infections; Bacterial Infections - epidemiology; Biological and medical sciences; Blood; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Comorbidity; Cyanosis; Demography; Drug therapy; Drug use; Emergency and intensive respiratory care; Female; Gestational age; Health aspects; Hospitalization; Hospitals; Humans; Infant; Infant, Newborn; Infections; Intensive care; Intensive care medicine; Leukocytes; Logistic Models; Male; Medical sciences; Multivariate Analysis; Netherlands - epidemiology; Pediatric respiratory diseases; Pediatrics; Respiration, Artificial; Respiratory syncytial virus; Respiratory syncytial virus infection; Respiratory Syncytial Virus Infections - epidemiology; Respiratory Syncytial Virus Infections - therapy; Respiratory Tract Infections - epidemiology; Respiratory Tract Infections - etiology; Respiratory Tract Infections - therapy; Retrospective Studies; Risk factors; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Ventilators
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-005-2614-4

To identify demographic, clinical, and laboratory variables predictive for a concurrent bacterial pulmonary infection in ventilated infants with respiratory syncytial virus (RSV) lower respiratory tract disease (LRTD) and investigate antimicrobial drug use. Retrospective, observational study in a 14-bed pediatric intensive care unit. 82 infants younger than 1 year of age with a virologically confirmed RSV LRTD during 1996-2001, of whom 65 were mechanically ventilated. Microbiological data were available from 38 ventilated infants, 10 of whom had a positive blood culture (n=1) or endotracheal aspirate (n=9) obtained upon admission to the pediatric intensive care unit (PICU). Infants with a positive culture had a lower mean gestational age but were otherwise demographically comparable to those with negative culture results. Infants with a positive culture were ventilated 4 days longer. Indicators for a concurrent bacterial infection were comparable between ventilated and nonventilated infants. Antimicrobial drugs were used in 95.1% of infants (100% of ventilated infants) with a mean duration of 7.8+/-0.3 days. The moment of initiation and duration of antimicrobial drug treatment varied considerably. We observed in ventilated infants a low occurrence of concurrent bacterial pulmonary infection, but infants with positive cultures needed prolonged ventilatory support. Improvement in the diagnosis of a pulmonary bacterial infection is warranted to reduce the overuse of antimicrobial drugs among ventilated infants with RSV LRTD and to restrict these drugs to the proper patients.