title: Concurrent bacterial infection and prolonged mechanical ventilation in infants with respiratory syncytial virus lower respiratory tract disease.
abstract: 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.
authors.affiliation: Department of Pediatric Intensive Care, VU University Medical Center, P.O. Box 7507, 1007 MB Amsterdam, The Netherlands. m.kneyber@vumc.nl
authors.forename: Martin C J
authors.initials: MC
authors.lastname: Kneyber
authors.forename: Heleen
authors.initials: H
authors.lastname: Blussé van Oud-Alblas
authors.forename: Margreet
authors.initials: M
authors.lastname: van Vliet
authors.forename: Cuno S P M
authors.initials: CS
authors.lastname: Uiterwaal
authors.forename: Jan L L
authors.initials: JL
authors.lastname: Kimpen
authors.forename: Adrianus J
authors.initials: AJ
authors.lastname: van Vught
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents