Concurrent bacterial infection and prolonged mechanical ventilation in infants with respiratory syncytial virus lower respiratory tract disease.
OBJECTIVE
To identify demographic, clinical, and laboratory variables predictive for a concurrent bacterial pulmonary infection in ventilated infants with respiratory syncytial virus (RSV) lower respiratory tract disease (LRTD) and investigate antimicrobial drug use.


METHODS
Retrospective, observational study in a 14-bed pediatric intensive care unit.


METHODS
82 infants younger than 1 year of age with a virologically confirmed RSV LRTD during 1996-2001, of whom 65 were mechanically ventilated.


RESULTS
Microbiological data were available from 38 ventilated infants, 10 of whom had a positive blood culture (n=1) or endotracheal aspirate (n=9) obtained upon admission to the pediatric intensive care unit (PICU). Infants with a positive culture had a lower mean gestational age but were otherwise demographically comparable to those with negative culture results. Infants with a positive culture were ventilated 4 days longer. Indicators for a concurrent bacterial infection were comparable between ventilated and nonventilated infants. Antimicrobial drugs were used in 95.1% of infants (100% of ventilated infants) with a mean duration of 7.8+/-0.3 days. The moment of initiation and duration of antimicrobial drug treatment varied considerably.


CONCLUSIONS
We observed in ventilated infants a low occurrence of concurrent bacterial pulmonary infection, but infants with positive cultures needed prolonged ventilatory support. Improvement in the diagnosis of a pulmonary bacterial infection is warranted to reduce the overuse of antimicrobial drugs among ventilated infants with RSV LRTD and to restrict these drugs to the proper patients.
Kneyber
Martin C J
MC
Department of Pediatric Intensive Care, VU University Medical Center, P.O. Box 7507, 1007 MB Amsterdam, The Netherlands. m.kneyber@vumc.nl
Blussé van Oud-Alblas
Heleen
H
van Vliet
Margreet
M
Uiterwaal
Cuno S P M
CS
Kimpen
Jan L L
JL
van Vught
Adrianus J
AJ
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology; D001424:Bacterial Infections / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D012121:Respiration, Artificial; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology* / Q000628:therapy; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents