Epidemiology and Outcomes of Bacterial Coinfection in Hospitalized Children With Respiratory Viral Infections: A
Nikita Patel1, Ban Al-Sayyed2, Taylor Gladfelter3
1Medical student (NP), University of Illinois College of Medicine at Peoria, IL.
Insights
Bacterial coinfection is rare in children hospitalized with viral respiratory illness, affecting only 3.5%. This low rate suggests antimicrobial misuse, as many children receive antibiotics unnecessarily, despite worse outcomes for those with coinfection.
Area of Science:
- Pediatric Infectious Diseases
- Hospital Epidemiology
- Antimicrobial Stewardship
Background:
- Bacterial coinfection is often suspected in children with viral respiratory illness.
- Empirical antimicrobial use is common in these pediatric cases.
- Understanding the true incidence and impact of coinfection is crucial for appropriate treatment.
Purpose of the Study:
- To determine the actual rate of bacterial coinfection in hospitalized children with viral respiratory illness.
- To assess the impact of bacterial coinfection on hospital course and patient outcomes.
- To evaluate the extent of antimicrobial misuse in this patient population.
Main Methods:
- Retrospective chart review of hospitalized children from January 2015 to December 2019.
- Analysis of respiratory viral panels and bacterial cultures (respiratory, urine, blood) within specified timeframes.
- Comparison of demographics, resource utilization, and outcomes between children with and without confirmed bacterial coinfection.
Main Results:
- True bacterial coinfection was identified in 3.5% of 2192 hospitalized children.
- Children with coinfection were younger, had higher rates of prematurity, and required more ICU admission and intubation.
- Coinfected patients experienced longer hospital stays, higher mortality, and increased healthcare costs compared to non-coinfected patients.
Conclusions:
- The incidence of bacterial coinfection in hospitalized children with viral infections is significantly low.
- Routine empirical antimicrobial administration appears to be widespread and potentially inappropriate.
- Bacterial coinfection is associated with increased resource utilization and poorer clinical outcomes in pediatric patients.
Objective:
Children with viral respiratory illness are often suspected of having bacterial coinfection. This study was designed to determine the impact of bacterial coinfection on hospital course and outcomes and the rate of antimicrobial misuse.
Methods:
Single-center retrospective chart review, including all hospitalized children who had a respiratory viral panel sent within 48 hours of admission from January 2015 to December 2019. Patients who had a positive respiratory, urine, blood culture within 24 hours of admission were identified. Demographics, resource utilization, and outcomes were compared between the 2 groups.
Results:
This study included 2192 patients. Of those, 269 patients had positive bacterial cultures. Out of these cultures from 192 patients were identified as contaminants. True bacterial coinfection was 3.5% (77/2192). Almost 1/3 of admitted patients were prescribed empiric antimicrobials. Children with bacterial coinfection tended to be younger (median age 8.4 months vs 16.3 months, p < 0.01) and had higher proportion of prematurity (23.3% vs 12.1%, p < 0.01). Children with bacterial coinfection were more likely to require ICU admission (37.6% vs 23.9%, p < 0.01) and intubation (28.5% vs 5.3 %, p < 0.01). They had higher ICU (5.7 days vs 1.9 days, p < 0.01) and hospital length of stay (4.0 days vs 2.0 days, p < 0.01), higher mortality (2.6% vs 0.2%, p = 0.02), and a higher median cost of hospital care ($3774.44 vs $2424.49.90, p < 0.01).
Conclusions:
The rate of bacterial coinfection in hospitalized children with viral infections is very low, which contradicts the routine administration of empiric antimicrobials. Patients with coinfection require more hospital resources and have worse clinical outcomes.
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