title: Impact of bacteria in nasal aspirates on disease severity of bronchiolitis.
abstract: BACKGROUND
  The effect of potentially pathogenic bacteria (PPB) on disease severity in patients with bronchiolitis is understudied.
  
  
  METHODS
  This prospective study was carried out in the Children's Hospital of Soochow University during the 2012-2013 autumn and winter seasons. We enrolled consecutive children < 2 years of age hospitalized with an attending physician's diagnosis of bronchiolitis. Nasopharyngeal aspirate samples were tested for multiple respiratory viruses and cultured for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus.
  
  
  RESULTS
  In all, 30% (188 patients) were positive for Strep. pneumoniae, H. influenzae, M. catarrhalis, and Staph. aureus. Length of stay (LOS) for patients with PPB was 4.0 days (interquartile range, IQR, 25th-75th percentile: 3.0-6.0 days) versus 3.0 days (IQR, 3.0-5.0 days) for patients without PPB (p < 0.001). However, requirement and duration of supplemental oxygen were not significantly different between the two groups. H. influenzae was an independent risk factor for hospital LOS ≥ 5.0 days (adjusted odds ratio, 1.75; 95% confidence interval, 1.06-2.91). The presence of PPB was not associated with increased risk of supplemental oxygen requirement.
  
  
  CONCLUSIONS
  Our study demonstrated that pediatricians should evaluate for PPB in patients with bronchiolitis, especially when they present with RSV infection, fever or percentage of neutrophils > 40%. The presence of H. influenzae in nasal aspirates is associated with longer LOS in patients with bronchiolitis.
authors.affiliation: a From the Department of Respiratory Medicine , Children's Hospital of Soochow University , Suzhou , China.
authors.forename: Wujun
authors.initials: W
authors.lastname: Jiang
authors.affiliation: a From the Department of Respiratory Medicine , Children's Hospital of Soochow University , Suzhou , China.
authors.forename: Ting
authors.initials: T
authors.lastname: Wang
authors.affiliation: a From the Department of Respiratory Medicine , Children's Hospital of Soochow University , Suzhou , China.
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.affiliation: a From the Department of Respiratory Medicine , Children's Hospital of Soochow University , Suzhou , China.
authors.forename: Wei
authors.initials: W
authors.lastname: Ji
authors.affiliation: a From the Department of Respiratory Medicine , Children's Hospital of Soochow University , Suzhou , China.
authors.forename: Yuqing
authors.initials: Y
authors.lastname: Wang
authors.affiliation: a From the Department of Respiratory Medicine , Children's Hospital of Soochow University , Suzhou , China.
authors.forename: Yongdong
authors.initials: Y
authors.lastname: Yan
mesh_terms: D001419:Bacteria / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000382:microbiology*; D001988:Bronchiolitis / Q000175:diagnosis / Q000382:microbiology*; D002675:Child, Preschool; D005260:Female; D006193:Haemophilus influenzae / Q000302:isolation & purification / Q000472:pathogenicity; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D001936:Moraxella catarrhalis / Q000302:isolation & purification / Q000472:pathogenicity; D017817:Nasal Lavage Fluid / Q000382:microbiology* / Q000821:virology; D011446:Prospective Studies; D018357:Respiratory Syncytial Virus Infections / Q000175:diagnosis; D012720:Severity of Illness Index; D013211:Staphylococcus aureus / Q000302:isolation & purification / Q000472:pathogenicity; D013296:Streptococcus pneumoniae / Q000302:isolation & purification / Q000472:pathogenicity
keywords: Bacteria; Haemophilus influenzae; bronchiolitis; children