Related Experiment Video
Updated: Jan 29, 2026
Generation and Assembly of Virus-Specific Nucleocapsids of the Respiratory Syncytial Virus
Published on: July 27, 2021
Antibiotic Prescription in Young Children With Respiratory Syncytial Virus-Associated Respiratory Failure and
Steven L Shein1, Michele Kong2, Bryan McKee1
1Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH.
Insights
Early antibiotic use in young children with respiratory syncytial virus infection on mechanical ventilation was linked to shorter hospital stays. This practice, though variable, may shorten the clinical course for these pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
- Respiratory viral infections
Background:
- Lower respiratory tract infections caused by respiratory syncytial virus (RSV) are a common reason for mechanical ventilation in young children.
- Antibiotic prescribing practices during mechanical ventilation for RSV infections are not well-described.
- The potential impact of early antibiotic use on clinical outcomes in this population requires investigation.
Purpose of the Study:
- To characterize antibiotic prescribing patterns within the first 48 hours of mechanical ventilation for children with RSV-associated lower respiratory tract infections.
- To assess the association between early antibiotic administration and clinical outcomes, including duration of mechanical ventilation and hospital length of stay.
Main Methods:
- A retrospective cohort study was conducted using data from 46 children's hospitals in the United States.
- The study included 2,107 children under two years old diagnosed with RSV-associated lower respiratory tract infection requiring mechanical ventilation between 2012 and 2016.
- Antibiotic prescription during the first two days of mechanical ventilation was the primary intervention, with clinical outcomes measured as duration of mechanical ventilation and hospital length of stay.
Main Results:
- Antibiotic prescription during the first two days of mechanical ventilation was common (82%), though it decreased over the study period and varied significantly across centers.
- Children receiving antibiotics on both of the first two days of mechanical ventilation had a shorter duration of mechanical ventilation (6 days vs. 8 days) and a shorter hospital length of stay (11 days vs. 13 days) compared to those not receiving antibiotics.
- After adjusting for covariates, early antibiotic prescription was associated with a 1.21-day reduction in mechanical ventilation duration and a 2.07-day reduction in hospital length of stay.
Conclusions:
- The practice of initiating antibiotics early in mechanically ventilated children with RSV lower respiratory tract infection, despite variability, is associated with a shortened clinical course.
- Further research is needed to optimize the identification and treatment of potential bacterial coinfections in this vulnerable pediatric population.
- A prudent approach to antibiotic stewardship is essential, balancing the need to treat bacterial coinfections with the risks of antibiotic resistance.
Objectives:
To describe antibiotic prescribing practices during the first 2 days of mechanical ventilation among previously healthy young children with respiratory syncytial virus-associated lower respiratory tract infection and evaluate associations between the prescription of antibiotics at onset of mechanical ventilation with clinical outcomes.
Design:
Retrospective cohort study.
Setting:
Forty-six children's hospitals in the United States.
Patients:
Children less than 2 years old discharged between 2012 and 2016 with an International Classification of Diseases diagnosis of respiratory syncytial virus-associated lower respiratory tract infection, no identified comorbid conditions, and receipt of mechanical ventilation.
Interventions:
Antibiotic prescription during the first 2 days of mechanical ventilation.
Measurements And Main Results:
We compared duration of mechanical ventilation and hospital length of stay between children prescribed antibiotics on both of the first 2 days of mechanical ventilation and children not prescribed antibiotics during the first 2 days of mechanical ventilation. We included 2,107 PICU children with respiratory syncytial virus-associated lower respiratory tract infection (60% male, median age of 1 mo [interquartile range, 1-4 mo]). The overall proportion of antibiotic prescription on both of the first 2 days of mechanical ventilation was 82%, decreasing over the study period (p = 0.004) and varying from 36% to 100% across centers. In the bivariate analysis, antibiotic prescription was associated with a shorter duration of mechanical ventilation (6 d [4-9 d] vs 8 d [6-11 d]; p < 0.001) and a shorter hospital length of stay (11 d [8-16 d] vs 13 d [10-18 d]; p < 0.001). After adjustment for center, demographics, and vasoactive medication prescription, antibiotic prescription was associated with a 1.21-day shorter duration of mechanical ventilation and a 2.07-day shorter length of stay. Ultimately, 95% of children were prescribed antibiotics sometime during hospitalization, but timing, duration, and antibiotic choice varied markedly.
Conclusions:
Although highly variable across centers and decreasing over time, the practice of instituting antibiotics after intubation in young children with respiratory syncytial virus-associated lower respiratory tract infection was associated with a shortened clinical course after adjustment for the limited available covariates. A prudent approach to identify and optimally treat bacterial coinfection is needed.
Related Concept Videos
01:21Acute Respiratory Failure-I
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...
01:21Acute Respiratory Failure-II
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:23Acute Respiratory Failure-IV
01:30Acute Respiratory Failure-III
01:31Anatomy of Respiratory System II: Lower Respiratory Tract
The Larynx
It is located between the pharynx and the trachea, acts as a passageway for air, and hosts several critical structures, such as the epiglottis, vocal cords, and glottis. The epiglottis acts as a gateway, guiding food to the...