Bacterial co-infection of the respiratory tract in ventilated children with bronchiolitis; a retrospective cohort study

Abstract

BackgroundViral bronchiolitis is the most common cause of respiratory failure requiring invasive ventilation in young children. Bacterial co-infections may complicate and prolong paediatric intensive care unit (PICU) stay. Data on prevalence, type of pathogens and its association with disease severity are limited though. These data are especially important as bacterial co-infections may be treated using antibiotics and could reduce disease severity and duration of PICU stay. We investigated prevalence of bacterial co-infection and its association with disease severity and PICU stay.MethodsRetrospective cohort study of the prevalence and type of bacterial co-infections in ventilated children performed in a 14-bed tertiary care PICU in The Netherlands. Children less than 2 years of age admitted between December 2006 and November 2014 with a diagnosis of bronchiolitis and requiring invasive mechanical ventilation were included. Tracheal aspirates (TA) and broncho-alveolar lavages (BAL) were cultured and scored based on the quantity of bacteria colony forming units (CFU) as: co-infection (TA > 10^5/BAL > 10^4 CFU), low bacterial growth (TA < 10^5/BAL < 10^4 CFU), or negative (no growth). Duration of mechanical ventilation and PICU stay were collected using medical records and compared against the presence of co-infection using univariate and multivariate analysis.ResultsOf 167 included children 63 (37.7%) had a bacterial co-infection and 67 (40.1%) low bacterial growth. Co-infections occurred within 48 h from intubation in 52 out 63 (82.5%) co-infections. H.influenza (40.0%), S.pneumoniae (27.1%), M.catarrhalis (22.4%), and S.aureus (7.1%) were the most common pathogens. PICU stay and mechanical ventilation lasted longer in children with co-infections than children with negative cultures (9.1 vs 7.7 days, p = 0.04 and 8.1vs 6.5 days, p = 0.02).ConclusionsIn this large study, bacterial co-infections occurred in more than a third of children requiring invasive ventilation for bronchiolitis and were associated with longer PICU stay and mechanical ventilation. These findings support a clinical trial of antibiotics to test whether antibiotics can reduce duration of PICU stay.

Acute viral bronchiolitis as a cause of pediatric acute respiratory distress syndrome

“…Concerning risk factors, we highlighted a significant association between bacterial co-infection and development of PARDS in our study cohort. This has also been shown in previous studies which have shown an association between bacterial co-infection, severe respiratory disease, and longer PICU stay [ 21 ]. None of the previous studies has demonstrated the association between bacterial co-infection and PARDS in AVB.…”

Viral etiology and outcome of severe lower respiratory tract infections among critically ill children admitted to the PICU

“…In the literature, bacterial co-infection rates range from 16% to 37%, with higher rates determined in the PICU. 30,31 Similar to our study, bacterial co-infection with typical organisms, such as Moraxella Catarrhalis, and Haemophilus Influenzae, have been reported in previous studies focused on patients in the PICU. 30,31 In previous studies, multiple viral infection rate is reported to be between 31 and 37%.…”

“…30,31 Similar to our study, bacterial co-infection with typical organisms, such as Moraxella Catarrhalis, and Haemophilus Influenzae, have been reported in previous studies focused on patients in the PICU. 30,31 In previous studies, multiple viral infection rate is reported to be between 31 and 37%. 32,33 Recent studies found hRV, RSV and AdV as the leading viruses in multiple infections.…”

A randomized controlled trial of a combination of antiviral and nonsteroidal anti-inflammatory treatment in a bovine model of respiratory syncytial virus infection

“…those infants ill enough to require intubation. [33,34]. Infants who are less ill are generally assumed to have only the virus and antibiotics are generally withheld; because such children are not intubated comparable data regarding bacteria in the lung are not available.…”