Risk of concurrent bacterial infection in preterm infants hospitalized due to respiratory syncytial virus infection

Resch, Bernhard; Gusenleitner, Walter; Mueller, W

doi:10.1111/j.1651-2227.2007.00226.x

Cited by 45 publications

(48 citation statements)

References 17 publications

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“…-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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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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“…RSV infection at a younger age often involves the lower respiratory tract and is frequently associated with expiratory wheezing, which is referred to as bronchiolitis or wheezy bronchitis, asthma, and pneumonia (1). It is known that RSV infections can be complicated by bacterial superinfections (2)(3)(4)(5). Nontypeable Haemophilus influenzae (NTHi) is one of the most common bacteria involved in mixed RSVbacterial bronchopulmonary infections in pediatric patients (2,4).…”

Section: R Espiratory Syncytial Virus (Rsv) Is One Of the Majormentioning

confidence: 99%

The Effects of Disodium Cromoglycate on Enhanced Adherence of Haemophilus influenzae to A549 Cells Infected With Respiratory Syncytial Virus

et al. 2009

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Nontypeable Haemophilus influenzae (NTHi) secondary infection often complicates respiratory syncytial virus (RSV) infections. Previous studies have revealed that RSV infections enhance NTHi adherence to airway epithelial cells. In this study, we investigated the effects of disodium cromoglycate (DSCG) and corticosteroids, which are frequently used for the treatment of wheezing often related to RSV infections, on the adherence of NTHi to RSV-infected A549 cells. DSCG inhibited enhanced adherence of NTHi to RSV-infected A549 cells, whereas dexamethasone (Dex) and fluticasone propionate (Fp) did not. DSCG suppressed the expression of ICAM-1, which is one of the NTHi receptors. Furthermore, DSCG exhibited an inhibitory effect on RSV infections. It is suggested that DSCG exerts an anti-RSV effect, and consequently attenuates the expression of NTHi receptors. (Pediatr Res 66: 168-173, 2009) R espiratory syncytial virus (RSV) is one of the major pathogens of upper and lower respiratory tract infections in children. RSV infection at a younger age often involves the lower respiratory tract and is frequently associated with expiratory wheezing, which is referred to as bronchiolitis or wheezy bronchitis, asthma, and pneumonia (1). It is known that RSV infections can be complicated by bacterial superinfections (2-5). Nontypeable Haemophilus influenzae (NTHi) is one of the most common bacteria involved in mixed RSVbacterial bronchopulmonary infections in pediatric patients (2,4). It has long been recognized that a preceding local respiratory viral infection seems to play an important role in the pathogenesis of infections by bacteria, including NTHi. The mechanisms underlying bacterial superinfections include virus-induced local destruction of the epithelium, which compromises the host's physiologic barrier, and virus-induced modulation of the immune response (6). In addition, enhanced bacterial adherence to virus-infected cells is considered an important factor increasing the risk of bacterial superinfections (7).Recent studies demonstrated that some respiratory viruses including RSV lead to both expression of viral glycoproteins and up-regulation of cellular molecules including ICAM-1 (CD54), carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1), and platelet activating factor receptor (PAFr) on the host-cell membrane. Both could serve as bacterial receptors and promote bacterial adhesion to the cells (8 -11). Strategies for preventing interaction between RSV and bacteria may reduce the incidence of secondary bacterial complications of RSV infection.Disodium cromoglycate (DSCG) and corticosteroids, which are recognized as inhalation drugs for the management of bronchial asthma, are also used for the treatment of acute infantile wheezing and exacerbation of asthma that are often related to RSV infections. The effects of these medicines against RSV infections and secondary bacterial complications are not clear. In this study, we investigated the effects of DSCG and corticosteroids on the in vitro inte...

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“…Current treatment and clinical management of paediatric ARI is another area requiring further investigation in light of the findings of this thesis and other recent studies (9)(10)(11)(13)(14)(15). Increased disease severity was found to be associated with S. pneumoniae presence during RSV infection; however, the best treatment strategies for RSV/S.…”

Section: Future Directionsmentioning

confidence: 93%

“…However, outside of epidemics, influenza is a relatively infrequent pathogen of young children (8). There is some evidence to suggest that bacterial co-infections with common paediatric viruses like RSV may be clinically relevant in young children (9)(10)(11)(12)(13)(14)(15). However, as healthy young children are often colonised by potentially pathogenic bacteria, distinguishing true bacterial co-infection, i.e.…”

Section: Introductionmentioning

confidence: 99%

“…pneumoniae or H. influenzae may be associated with more severe RSV infections in young children (9)(10)(11)(13)(14)(15). The majority of paediatric ARI studies investigating associations between specific viral and bacterial interactions and disease severity have taken place in temperate climates in the northern hemisphere (9-11, 14, 15, 54, 57, 98).…”

Section: Introductionmentioning

confidence: 99%

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Viral/bacterial respiratory tract co-infections in children

Brealey¹

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Respiratory syncytial virus (RSV) is the most significant cause of paediatric acute respiratory infection (ARI). RSV and other respiratory viruses are commonly co-detected with potentially pathogenic bacteria, such as Streptococcus pneumoniae, in the upper airways of young children.While these bacteria are known to be carried asymptomatically, they are also capable of opportunistic infections. Interactions between RSV and S. pneumoniae have been demonstrated in both clinical and molecular studies. However, the clinical significance of these interactions remains debated, and the effect of clinically relevant strain variation in both virus and bacteria on these interactions is also unknown. This work aimed to better understand the role of S. pneumoniae colonisation during RSV infections.To determine the effect of RSV and S. pneumoniae co-detection on disease severity during ARI, molecular pathogen screening of nasopharyngeal samples was conducted in a cohort of young children under the age of two years presenting with ARI at the emergency department of the Royal Brisbane Children's Hospital, Australia. S. pneumoniae was co-detected in approximately 52% of RSV infections, and co-detection was associated with increased disease severity, suggesting that S. pneumoniae plays a pathogenic role in severe paediatric RSV infections.Having established a clinical role for S. pneumoniae during RSV infection, the dynamics of pneumococcal colonisation of the nasal cavity was investigated in the four weeks prior and subsequent to an RSV infection in a longitudinal birth cohort of Brisbane-based children.Approximately 33% of infants and young children with RSV infections were colonised by S. pneumoniae prior to the RSV detection, and strain characterisation of S. pneumoniae in the weeks immediately surrounding the viral infection suggested that any observed growth of S. pneumoniae during RSV infection arose from the pre-existing strain colonising the URT. In another 14% of RSV infections, S. pneumoniae was first detected during the virus infection, suggesting simultaneous acquisition of RSV and S. pneumoniae and possible co-transmission of the two pathogens.The results from the two paediatric cohorts suggested an interaction between RSV and S.pneumoniae that was advantageous to the bacteria. It was therefore hypothesised that the molecular mechanisms governing RSV and S. pneumoniae interactions might be pneumococcal strain-specific and stronger in strains frequently co-detected with RSV. Studies have shown that RSV can increase S. pneumoniae colonisation by enhancing pneumococcal adherence to airway epithelia, and virions iii can bind directly to the bacterium to form co-pathogen complexes. These interactions are in part mediated through the binding interactions between S. pneumoniae surface receptors and the RSV G surface glycoprotein. RSV G is highly variable, both antigenically and genetically, and is the main protein used to type RSV into subtypes A and B. The genetic variation of RSV G was characterised from nasophar...

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Risk of concurrent bacterial infection in preterm infants hospitalized due to respiratory syncytial virus infection

Abstract: The overall low risk of concurrent bacterial infection was significantly increased in preterm infants associated with prolonged hospitalization and ICU admission.

Cited by 45 publications

References 17 publications

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

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

The Effects of Disodium Cromoglycate on Enhanced Adherence of Haemophilus influenzae to A549 Cells Infected With Respiratory Syncytial Virus

Viral/bacterial respiratory tract co-infections in children

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