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Published on: August 7, 2017
Impact of Respiratory Bacterial Codetection on Outcomes in Ventilated Infants With Bronchiolitis
Manzilat Akande1, Sandra P Spencer2, Melissa Moore-Clingenpeel3
1From the Section of Critical Care, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
Insights
Bacterial coinfection in infants with bronchiolitis requiring intubation is common. Early antibiotics may shorten mechanical ventilation duration and intensive care unit stays, warranting further study.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Viral bronchiolitis frequently causes acute respiratory failure in infants, often necessitating intubation.
- The prevalence and impact of bacterial respiratory tract infections co-occurring with bronchiolitis remain unclear, particularly with evolving respiratory support strategies.
Purpose of the Study:
- To investigate the association between bacterial codetection and clinical outcomes in infants intubated for bronchiolitis.
- To evaluate the impact of bacterial coinfection on mechanical ventilation duration and intensive care unit (ICU) length of stay.
Main Methods:
- A single-center retrospective cohort study included children under 2 years old requiring emergency department intubation for bronchiolitis (2012-2017).
- Viral testing and lower respiratory cultures were performed. Bacterial codetection was defined by a positive culture and significant inflammatory markers on Gram stain.
- Multivariable gamma regression analyzed the effect of bacterial codetection on mechanical ventilation (MV) duration and ICU length of stay.
Main Results:
- Of 149 patients, 52% showed bacterial codetection.
- Bacterial codetection was associated with significantly shorter MV duration (adjusted relative risk [aRR] 0.819) and ICU length of stay (aRR 0.806).
- The benefit of codetection on ventilation duration was more pronounced with earlier antibiotic administration.
Conclusions:
- Bacterial codetection is prevalent in infants with severe bronchiolitis requiring intubation.
- Codetection is linked to reduced mechanical ventilation duration and ICU stay, potentially influenced by early antibiotic use.
- Further multicenter research is essential to elucidate the precise roles of bacterial codetection and antibiotic timing in bronchiolitis management.
Background:
Viral bronchiolitis is a common cause of acute respiratory failure requiring intubation for infants. Bacterial respiratory tract infections can occur with bronchiolitis, although their prevalence and impact on outcomes are unclear, especially with increased use of noninvasive respiratory support.
Methods:
This was a single-center retrospective cohort study of children <2 years old requiring intubation in the emergency department for bronchiolitis from 2012 to 2017 who had viral testing plus a lower respiratory culture obtained. We evaluated the impact of bacterial codetection (positive respiratory culture plus moderate or many polymorphonuclear neutrophils on Gram stain) on mechanical ventilation (MV) duration and intensive care unit length of stay using multivariable gamma regression.
Results:
Of 149 patients enrolled, 52% had bacterial codetection. In adjusted analysis, patients with codetection had shorter MV duration [adjusted relative risk (aRR) 0.819, 95% confidence interval (CI): 0.69-0.98; marginal mean duration of 5.31 days (4.71-5.99) compared to 6.48 days (5.72-7.35) without codetection]. Patients with codetection had a shorter intensive care unit stay [aRR 0.806 (0.69-0.94); marginal mean length of stay 6.9 days (6.21-7.68) vs. 8.57 days (7.68-9.56) without codetection]. The association between codetection and duration of ventilation appears confined to those receiving earlier antibiotics (less than the median time) rather than later antibiotics [aRR 0.738 (0.56-0.95) for earlier vs. aRR 0.92 (0.70-1.18) for later].
Conclusions:
Respiratory bacterial codetection is common and associated with shorter MV duration in infants requiring early intubation for bronchiolitis. Early antibiotics may contribute to these outcomes, but further multicenter studies are needed to understand the role of codetection and antibiotics on bronchiolitis outcomes.
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