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The study aim was to examine the incidence and risk factors of respiratory syncytial virus (RSV) bronchiolitis hospitalisations and disease severity among infants. We compared demographic and health characteristics of children aged 0-23 hospitalised for RSV bronchiolitis (cases, n=1,227) during 2008-2018 and control children (n=554) of the same age admitted for non-respiratory disease. RSV antigen was detected in nasal swabs by immunochromatography. Multiple logistic regression models were applied. The average annual incidence of hospitalisation for RSV bronchiolitis was 12.6 per 1,333 and 1.7 per 1,000 (P<0.001) among infants and toddlers, respectively, with winter seasonality (November-March). The risk of hospitalisation for RSV bronchiolitis increased among children aged 0-5 months (OR 7.66; 95% CI 5.61-10.45) and 6-11 months (OR 12.88, 95% CI 0.48-11.55), compared to those aged 12-23 months. Additional risk factors were living in low vs. higher socioeconomic status towns (OR 1.49; 95% CI 1.14-1.95), having chronic medical conditions (OR 2.75; 95% CI 1.61-4.70), birth month (October-January vs.June-September) (OR 2.19; 95% CI 1.60-2.99), and history of stay in neonatal intensive care unit at birth (OR 2.37;. Male children and those who had pneumonia were more likely to have severe RSV bronchiolitis. In conclusion, the burden of hospitalisations for RSV bronchiolitis is high, especially in young infants. Effective preventive measures such as RSV active vaccines can reduce the risk of hospitalisations for RSV bronchiolitis among these vulnerable groups.

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Background: Respiratory syncytial virus (RSV) is a main cause of respiratory tract infections, especially affecting young children. Antibiotics are often unnecessarily prescribed for the treatment of RSV. Such treatments can have effects on antibiotic resistance in future bacterial infections of treated patients and the general population. Objectives: We sought to understand the risk factors for and patterns of unnecessary antibiotic prescription in children with RSV. Methods: In a single center retrospective study in Israel, we obtained data of children aged <2 years (n=1015) hospitalized for RSV-bronchiolitis during 2008-2018, and ascertained not to have bacterial coinfections. Antibiotic misuse was defined as prescription of antibiotics during hospitalization of the study population. Patient and clinical variables were assessed as predictors of unnecessary antibiotic treatment in a multivariable logistic regression model. Results: Unnecessary antibiotic treatment rate of children infected with RSV and ascertained not to have a bacterial coinfection was estimated at 33.4% (95% CI 30.5%-36.4%). Increased likelihood of antibiotic misuse was associated with drawing bacterial cultures, and with variables indicative of a severe patient status: lower oxygen saturation, higher body temperature, tachypnea and prior recent emergency room visit. Older age and female sex were also associated with increased likelihood of unnecessary antibiotic treatment. Conclusions: Unnecessary antibiotic treatment in RSV patients was highly common and may be largely attributed to the physicians' perception of patients' severity. Improving prescription guidelines, implementing antibiotic stewardship programs and utilizing decision support systems may help achieve a better balance between prescribing and withholding antibiotic treatment.