Bacteremia in Children Hospitalized with Respiratory Syncytial Virus Infection

Abstract

BackgroundThe risk of bacteremia is considered low in children with acute bronchiolitis. However the rate of occult bacteremia in infants with RSV infection is not well established. The aim was to determine the actual rate and predictive factors of bacteremia in children admitted to hospital due to confirmed RSV acute respiratory illness (ARI), using both conventional culture and molecular techniques.MethodsA prospective multicenter study (GENDRES-network) was conducted between 2011–2013 in children under the age of two admitted to hospital because of an ARI. Among those RSV-positive, bacterial presence in blood was assessed using PCR for Meningococcus, Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus pyogenes, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, and Staphylococcus aureus, in addition to conventional cultures.Results66 children with positive RSV respiratory illness were included. In 10.6% patients, bacterial presence was detected: H. influenzae (n = 4) and S. pneumoniae (n = 2). In those patients with bacteremia, there was a previous suspicion of bacterial superinfection and had received empirical antibiotic treatment 6 out of 7 (85.7%) patients. There were significant differences in terms of severity between children with positive bacterial PCR and those with negative results: PICU admission (100% vs. 50%, P-value = 0.015); respiratory support necessity (100% vs. 18.6%, P-value < 0.001); Wood-Downes score (mean = 8.7 vs. 4.8 points, P-value < 0.001); GENVIP scale (mean = 17 vs. 10.1, P-value < 0.001); and length of hospitalization (mean = 12.1 vs. 7.5 days, P-value = 0.007).ConclusionBacteremia is not frequent in infants hospitalized with RSV respiratory infection, however, it should be considered in the most severe cases.

Vitamin D Induces Differential Effects on Inflammatory Responses During Bacterial and/or Viral Stimulation of Human Peripheral Blood Mononuclear Cells

“…Streptococcus pneumoniae (pneumococcus) and respiratory syncytial virus (RSV) are the leading causes of lower respiratory tract infections (LRTIs) amongst children and older adults (1,2). Importantly, co-infections with these pathogens are becoming increasingly recognized as a major contributor to severe LRTIs requiring hospitalizations (3,4). Innate responses to RSV or pneumococcal bacteria can prime the host for secondary infection by activating inflammatory cells such as macrophages and neutrophils (5,6).…”

Peptidoglycan from Immunobiotic Lactobacillus rhamnosus Improves Resistance of Infant Mice to Respiratory Syncytial Viral Infection and Secondary Pneumococcal Pneumonia

“…Clinical and epidemiologic data suggest that RSV is linked to increases in the frequency ( 5 ) and severity ( 6 ) of pneumococcal disease. It was also demonstrated that mice infected with RSV before pneumococcal challenge as well as mice infected with both respiratory pathogens simultaneously showed enhanced lung alterations and elevated levels of bacteremia ( 7 , 8 ).…”

Importance of Respiratory Syncytial Virus as a Predictor of Hospital Length of Stay in Bronchiolitis

“…Several predictive models had reports consistently the chest indrawing as predictive of prolonged LOS that is which is biologically plausible and expected due that this sign also is a universal marker of severity of the disease, as well as the presence of underlying conditions (congenital heart disease, chronic lung conditions, immunocompromised states) (3,(6)(7)(8)(20)(21)(22) or C-reactive protein (CRP) as a biomarker of severity and bacterial co-infection in patients hospitalized for bronchiolitis (23)(24)(25) Our study has limitations. First, since this study was based on medical records review, we cannot include other variables such as environmental pollution and genetic factors, and residual confounding cannot be excluded.…”