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Published on: August 7, 2017
Prevalence of Bacterial Codetection and Outcomes for Infants Intubated for Respiratory Infections
Todd Karsies1, Steven L Shein2, Franco Diaz3,4,5
1Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH.
Insights
Bacterial coinfection was found in nearly a third of young children intubated for lower respiratory tract infections. This bacterial coinfection did not prolong mechanical ventilation duration in pediatric intensive care units.
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.
Objectives:
To determine the prevalence of respiratory bacterial codetection in children younger than 2 years intubated for acute lower respiratory tract infection (LRTI), primarily viral bronchiolitis, and identify the association of codetection with mechanical ventilation duration.
Design:
Prospective observational study evaluating the prevalence of bacterial codetection (moderate/heavy growth of pathogenic bacterial plus moderate/many polymorphonuclear neutrophils) and the impact of codetection on invasive mechanical ventilation (IMV) duration.
Setting:
PICUs in 12 high and low/middle-income countries.
Patients:
Children younger than 2 years old requiring intubation and ICU admission for LRTI and who had a lower respiratory tract culture obtained at the time of intubation between December 1, 2019, and November 30, 2020.
Interventions:
None.
Measurements And Main Results:
Of the 472 analyzed patients (median age 4.5 mo), 55% had a positive respiratory culture and 29% ( n = 138) had codetection. 90% received early antibiotics starting at a median of 0.36 hours after respiratory culture. Median (interquartile range) IMV duration was 151 hours (88, 226), and there were 28 deaths (5.3%). Codetection was more common with younger age, a positive respiratory syncytial virus test, and an admission diagnosis of bronchiolitis; it was less common with an admission diagnosis of pneumonia, with admission to a low-/middle-income site, and in those receiving vasopressors. When adjusted for confounders, codetection was not associated with longer IMV duration (adjusted relative risk 0.854 [95% CI 0.684-1.065]). We could not exclude the possibility that codetection might be associated with a 30-hour shorter IMV duration compared with no codetection, although the CI includes the null value.
Conclusions:
Bacterial codetection was present in almost a third of children younger than 2 years requiring intubation and ICU admission for LRTI, but this was not associated with prolonged IMV. Further large studies are needed to evaluate if codetection is associated with shorter IMV duration.
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