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Prevalence of and Risks for Bacterial Infections in Hospitalized Children With Bronchiolitis
Noelle Cadotte1,2, Hannah Moore3, Bryan L Stone4
1Divisions of Critical Care.
Insights
Serious bacterial infections (cSBIs) are uncommon in children hospitalized with bronchiolitis. Key risk factors include mechanical ventilation, elevated C-reactive protein, chronic conditions, and PICU admission.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Viral bronchiolitis is a frequent pediatric hospitalization diagnosis.
- Concurrent serious bacterial infections (cSBIs) are possible but challenging to identify.
- Accurate identification of cSBI is crucial to guide appropriate antibiotic use.
Purpose of the Study:
- To determine the prevalence of cSBI in hospitalized pediatric bronchiolitis cases.
- To identify risk factors associated with cSBI in this population.
Main Methods:
- Retrospective cohort study of children under 2 years old hospitalized with bronchiolitis (2012-2019).
- cSBI defined as bacteremia, urinary tract infection, meningitis, or pneumonia.
- Logistic regression used to identify risk factors.
Main Results:
- 7871 admissions identified; 4.2% had at least one cSBI.
- Bacterial pneumonia was the most common cSBI (3.5%).
- Increased risk of cSBI associated with invasive mechanical ventilation, elevated C-reactive protein (≥4 mg/dL), complex chronic conditions, and PICU admission.
Conclusions:
- cSBIs are infrequent in pediatric bronchiolitis hospitalizations.
- Pneumonia is the most prevalent cSBI.
- Specific factors like mechanical ventilation and PICU admission indicate higher cSBI risk.
Background And Objectives:
Viral bronchiolitis is a common pediatric illness. Treatment is supportive; however, some children have concurrent serious bacterial infections (cSBIs) requiring antibiotics. Identifying children with cSBI is challenging and may lead to unnecessary treatment. Improved understanding of the prevalence of and risk factors for cSBI are needed to guide treatment. We sought to determine the prevalence of cSBI and identify factors associated with cSBI in children hospitalized with bronchiolitis.
Methods:
We performed a retrospective cohort study of children <2 years old hospitalized with bronchiolitis at a free-standing children's hospital from 2012 to 2019 identified by International Classification of Diseases codes. cSBI was defined as bacteremia, urinary tract infection, meningitis, or pneumonia. Risk factors for cSBI were identified using logistic regression.
Results:
We identified 7871 admissions for bronchiolitis. At least 1 cSBI occurred in 4.2% of these admissions; with 3.5% meeting our bacterial pneumonia definition, 0.4% bacteremia, 0.3% urinary tract infection, and 0.02% meningitis. cSBI were more likely to occur in children with invasive mechanical ventilation (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.78-3.63), a C-reactive protein ≥4 mg/dL (OR 2.20, 95% CI 1.47-3.32), a concurrent complex chronic condition (OR 1.67, 95% CI 1.22-2.25) or admission to the PICU (OR 1.46, 95% CI 1.02-2.07).
Conclusions:
cSBI is uncommon among children hospitalized with bronchiolitis, with pneumonia being the most common cSBI. Invasive mechanical ventilation, elevated C-reactive protein, presence of complex chronic conditions, and PICU admission were associated with an increased risk of cSBI.
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