Infant botulism: a descriptive study in a pediatric intensive care unit

Area of Science:

• Pediatric Intensive Care
• Infectious Diseases
• Clinical Microbiology

Background:

• Infant botulism (IB) is the most common form of human botulism in Argentina.
• Effective management of IB requires timely diagnosis and intervention.

Purpose of the Study:

• To describe the diagnostic and management characteristics of infant botulism (IB) patients in a pediatric intensive care unit (PICU) in Argentina.
• To evaluate the diagnostic delay and its impact on treatment and patient outcomes.

Main Methods:

• Observational, descriptive, retrospective study of IB patients admitted to the PICU between 2005 and 2020.
• Data collected included demographics, diagnostic methods (serum bioassay), mechanical ventilation use (conventional and non-invasive), tracheostomy, antibiotic use, length of stay, and mortality.
• Analysis focused on diagnostic confirmation time and treatment interventions.

Main Results:

• Twenty-one IB patients were identified, with a median age of 5 months. Diagnosis was confirmed by serum bioassay in 12 patients.
• A significant diagnostic delay of 15.8 days was observed, exceeding recommended timelines for specific treatment.
• No patients received antitoxin; 18 received antibiotics, and 5 received non-invasive ventilation. One patient required a tracheostomy. Median PICU stay was 48 days, with 37 days on conventional mechanical ventilation.

Conclusions:

• The bioassay technique, while confirming IB, led to diagnostic delays that precluded timely administration of specific treatments.
• Infant botulism in this cohort had low mortality but was associated with prolonged mechanical ventilation and hospital stays.
• Prolonged care was linked to cross-infections and extensive antibiotic use, highlighting areas for improved management strategies.