Risk of Bacterial Infection in Previously Healthy Respiratory Syncytial Virus-Infected Young Children Admitted to the Intensive Care Unit

Abstract

Objective-To evaluate the risk of bacterial infection and use of antibiotics in otherwise healthy children infected with respiratory syncytial virus (RSV) admitted to the intensive care unit (ICU).Methods-Demographics, clinical information, interventions and outcomes were extracted from the charts of consecutive patients with laboratory-confirmed RSV infection at Children's Hospital, Boston from October 1990 through April 2002. Patients born at <36 weeks gestational age or with preexisting medical conditions were excluded.Results-The median age of the 165 previously healthy infants infected with RSV was 42 days. Almost all patients received supplementary FiO 2 , and 63 (38.2%) patients required mechanical ventilator support. No patients died. The median length of stay was 3 days in the ICU and 7 days in the hospital. Most patients had bacterial cultures sent: 155 (93.9%), blood cultures; 121 (73.3%), urine cultures; and 85 (51.5%) cerebrospinal fluid cultures. Only 1 blood culture was positive, and 1 potential urinary tract infection was identified in a patient with a negative urinalysis. All intubated patients and 80.4% of nonintubated patients received antibiotic therapy.Conclusions-In otherwise healthy infants admitted to the ICU with RSV infection, bacteremia, urinary tract infection and meningitis are uncommon. Although bacterial pneumonia in this cohort may be more prevalent, overdiagnosis is common. Keywordsrespiratory syncytial virus; bronchiolitis; intensive care unit; sepsis Respiratory syncytial virus (RSV) commonly infects the lower respiratory tract of infants and young children and is the most common pathogen causing bronchiolitis. Although ∼1-2% of all children are hospitalized for viral lower respiratory infections in infancy, 1 only 5-10% of these hospitalized infants require intensive care in a specialized unit (ICU). Many infants admitted to the ICU with RSV infection have underlying conditions such as cardiac disease, immunocompromise or chronic lung disease that predispose them to a more severe clinical course. 2 Additionally the small airways of very young, otherwise healthy infants can also lead to significant respiratory compromise from RSV infection requiring mechanical ventilator support.Very young infants are at high risk for serious sequelae of bacterial infection and a standard laboratory evaluation (white blood cell count, urinalysis, cerebrospinal fluid (CSF) analysis and blood, urine and CSF cultures) is generally considered for infants presenting with fever NIH Public Access The objective of this study was to identify the risk of bacteremia, bacterial meningitis, urinary tract infection and bacterial pneumonia in otherwise healthy infants admitted to a a single pediatric intensive care unit during a 12-year period and to describe antibiotic use and potential rationale for use in this population. MethodsRSV was identified by enzyme-linked immunosorbent assay, direct fluorescent antibody or viral culture from samples obtained from nasal washes, nasopharyngeal swabs or endot...

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