Antibiotic use in pediatric intensive care patients with lower respiratory tract infection due to respiratory syncytial virus

Woensel, Job B. M. van; Rosenstiel, Inès A. von; Kimpen, Jan L. L.; Spanjaard, Lodewijk; Aalderen, W. M. C. van

doi:10.1007/s001340100995

Cited by 16 publications

(15 citation statements)

References 6 publications

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“…S pneumoniae was notoriously associated [3,18]. Our findings were in agreement with those reported by ourselves as well as other investigators [3,[18][19][20]. Comparing the 3 common viruses in PICU admissions, the mean age of children admitted with RSV was lower than of those with influenza or parainfluenza (1.2 vs 5.6 vs 2.4 years, P = .003) [3].…”

Section: Discussionsupporting

confidence: 95%

Respiratory syncytial virus morbidity, premorbid factors, seasonality, and implications for prophylaxis

Hon

Leung

Cheng

et al. 2012

Journal of Critical Care

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Section: Discussionsupporting

confidence: 95%

Respiratory syncytial virus morbidity, premorbid factors, seasonality, and implications for prophylaxis

Hon

Leung

Cheng

et al. 2012

Journal of Critical Care

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“…Forty percent of the patients in the group ventilated mechanically had nosocomial infection and the number of days spent in the pediatric intensive care unit was significantly higher than in the control group, rendering them at a higher risk for transmission of nosocomial pathogens. The vast majority of the group ventilated mechanically patients (85%) received antibiotic treatment, which is in agreement with other studies investigating patients with RSV infection admitted to the pediatric intensive care unit [van Woensel et al, 2001;Bloomfield et al, 2004]. Although antibiotic coverage is reasonable in a ventilated child with clinical and radiological signs of pneumonia, the duration of the antibiotic treatment and the methods of confirmation of bacterial super infection still remain a matter of debate.…”

Section: Discussionsupporting

confidence: 85%

“…-Mucosal injury during intubation might lead to an impaired mucociliary clearance. -Tracheal colonization during ventilation may contribute to a higher risk of secondary ventilator associated pneumonia [Cordero et al, 2000;van Woensel et al, 2001;Zar and Cotton, 2002;Resch et al, 2007] as the presence of an endotracheal tube provides a direct route for colonizing bacteria to enter the lower respiratory tract. -Most infants receiving mechanical ventilation are fed enterally via a nasogastric or orogastric tube.…”

Section: Discussionmentioning

confidence: 99%

Respiratory syncytial virus infection in children admitted to hospital but ventilated mechanically for other reasons

Renesse

Schildgen

Klinkenberg

et al. 2008

Journal of Medical Virology

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One thousand five hundred sixty-eight RSV infections were documented prospectively in 1,541 pediatric patients. Of these, 20 (1.3%) had acquired the RSV infection while treated by mechanical ventilation for reasons other than the actual RSV infection (group ventilated mechanically). The clinical characteristics of children who were infected with respiratory syncytial virus (RSV) infection while ventilated mechanically for other reasons are described and compared with a matched control group. Sixty percent of the group ventilated mechanically had at least one additional risk factor for a severe course of infection (prematurity 50%, chronic lung disease 20%, congenital heart disease 35%, immunodeficiency 20%). The median age at diagnosis in the group ventilated mechanically was 4.2 months. The matched pairs analysis (group ventilated mechanically vs. control group) revealed a higher proportion of patients with hypoxemia and apnoea in the group ventilated mechanically; more patients in the control group showed symptoms of airway obstruction (wheezing). At least one chest radiography was performed in 95% of the patients (n ¼ 19) in the group ventilated mechanically versus 45% (n ¼ 9) in the control group (P ¼ 0.001). The frequency of pneumonia was 40% in the group ventilated mechanically and 20% in the control group. Despite existing consensus recommendations, only two patients (10%) of the group ventilated mechanically had received palivizumab previously. Significantly more patients in the group ventilated mechanically received antibiotic treatment (85% vs. 45%, P ¼ 0.008), and attributable mortality was higher in the group ventilated mechanically (15% [n ¼ 3] vs. 0% in the control group, P ¼ 0.231). Children treated by long term mechanical ventilation may acquire RSV infection by transmission by droplets or caregivers and face an increased risk of a severe course of RSV infection. The low rate of immunoprophylaxis in this particular risk group should be improved.

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“…The radiological appearance of these lobar or segmental or diffuse pneumonias is highly variable and must not automatically be taken for a bacterial RTI. Nonetheless, due to diagnostic uncertainties it seems reasonable to treat all children with radiologically confirmed 'other pneumonias' initially with an appropriate antibiotic, in particular those admitted to the intensive care unit [46].…”

Section: Discussionmentioning

confidence: 99%

Respiratory syncytial virus infection in 406 hospitalized premature infants: results from a prospective German multicentre database

et al. 2007

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Premature birth, chronic lung disease of prematurity (CLD), congenital heart disease and immunodeficiency predispose to a higher morbidity and mortality in respiratory syncytial virus (RSV) infection. This study describes the preterms hospitalised with RSV infection from the prospective German DSM RSV Paed database. The DMS RSV Paed database was designed for the prospective multicentre documentation and analysis of clinically relevant aspects of the management of inpatients with RSV infection. This study covers six consecutive RSV seasons (1999-2005); the surveillance took place in 14 paediatric hospitals in Germany. Of the 1,568 prospectively documented RSV infections, 26% (n=406) were observed in preterms [vs. 1,162 children born at term (74%)] and 3% (n=50) had CLD, of which 49 had received treatment in the last 6 months ('CLDplus'). A significantly higher proportion in the preterm group had congenital heart disease, nosocomial infection, and neuromuscular impairment. There were significantly more children older than 24 months in the preterm group. The attributable mortality was 0.2% (n=2) in children born at term vs. 1.2% (n=5) in the preterm group (p=0.015) [preterm plus CLD 8.0% (n=4 of 50); McIntosh grade 1, 8.6% (n=3 of 35) and McIntosh Grade 4, 15% (n=3 of 20)]. Eight patients were categorized as 'palivizumab failures'. In the multivariate analysis, premature birth, CLD(plus), and nosocomial infection were significantly and independently associated with the combined outcome 'complicated course of disease'. In conclusion, this is the first prospective multicentre study from Germany that confirms the increased risk for severe RSV disease in preterms, in particular in those with CLD treated in the last 6 months before the onset of the infection. From the perspective of our results, the statements of the German Society of Paediatric Infectious Diseases considering the use of passive immunisation (2003) seem reasonable.

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Antibiotic use in pediatric intensive care patients with lower respiratory tract infection due to respiratory syncytial virus

Cited by 16 publications

References 6 publications

Respiratory syncytial virus morbidity, premorbid factors, seasonality, and implications for prophylaxis

Respiratory syncytial virus morbidity, premorbid factors, seasonality, and implications for prophylaxis

Respiratory syncytial virus infection in children admitted to hospital but ventilated mechanically for other reasons

Respiratory syncytial virus infection in 406 hospitalized premature infants: results from a prospective German multicentre database

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