Prevalence of Bacterial Codetection and Outcomes for Infants Intubated for Respiratory Infections

Area of Science:

• Pediatric critical care medicine
• Infectious diseases
• Respiratory medicine

Background:

• Acute lower respiratory tract infections (LRTI) are common in infants.
• Viral infections, such as bronchiolitis, are the primary cause of LRTI in young children.
• Bacterial coinfection can complicate viral LRTI, potentially impacting clinical outcomes.

Purpose of the Study:

• To determine the prevalence of bacterial coinfection in intubated children under 2 years old with LRTI.
• To investigate the association between bacterial coinfection and the duration of invasive mechanical ventilation (IMV).

Main Methods:

• Prospective observational study conducted in Pediatric Intensive Care Units (PICUs) across 12 countries.
• Included children younger than 2 years requiring intubation for LRTI, with lower respiratory tract cultures obtained at intubation.
• Bacterial codetection defined as moderate/heavy growth of pathogenic bacteria plus moderate/many neutrophils.

Main Results:

• Bacterial codetection occurred in 29% of 472 analyzed patients (median age 4.5 months).
• Codetection was more frequent in younger children, with positive RSV tests, and bronchiolitis diagnoses.
• Bacterial codetection was not associated with a longer duration of IMV (aRR 0.854 [95% CI 0.684-1.065]).

Conclusions:

• Bacterial coinfection is prevalent in intubated children with LRTI but does not appear to prolong mechanical ventilation.
• Further research is warranted to explore potential associations between bacterial coinfection and shorter IMV durations.