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Bacterial-like inflammatory response in children with adenovirus leads to inappropriate antibiotic use: a multicenter
Cristina Moracas1,2, Marco Poeta3,4, Francesca Grieco5
1Pediatric Infectious Disease Unit, Department of Maternal and Child health, University Hospital "Federico II", Naples, 80131, Italy.
Insights
Human Adenovirus (HAdV) infection in children causes a stronger inflammatory response but less severe respiratory symptoms than other viruses. Early HAdV identification can prevent unnecessary antibiotic use.
Area of Science:
- Pediatrics
- Infectious Diseases
- Virology
Background:
- Human Adenovirus (HAdV) is a common viral pathogen in children.
- Understanding the clinical spectrum of HAdV compared to other respiratory viruses is crucial for appropriate management.
- Differentiating viral etiologies in pediatric respiratory infections can be challenging.
Purpose of the Study:
- To compare the clinical severity of Human Adenovirus (HAdV) infection with other viral diseases in a cohort of children.
- To evaluate the presentation, therapy, and outcomes of HAdV infection in pediatric patients.
- To identify factors influencing clinical presentation and treatment in children with HAdV.
Main Methods:
- A retrospective multicenter cohort study was conducted in Italian children hospitalized with respiratory symptoms between January and December 2023.
- Children with HAdV infection presenting with respiratory symptoms were included; those with isolated gastrointestinal involvement or bacterial coinfection were excluded.
- Clinical data, including symptoms, laboratory markers, and treatment, were analyzed and compared between HAdV-infected and other viral groups.
Main Results:
- A total of 171 children were enrolled: 98 with HAdV and 73 with other viruses.
- HAdV-infected children showed higher C-reactive protein levels (50.8 vs. 16.5 mg/L) and longer fever duration (4.9 vs. 3.4 days).
- Despite less frequent respiratory distress and hypoxemia, HAdV cases were more likely to receive antibiotics (77.6% vs. 27.4%).
Conclusions:
- HAdV infection in children is associated with a more pronounced inflammatory response and prolonged fever, despite less severe respiratory symptoms.
- The strong inflammatory markers and fever often lead to empirical antibiotic overuse before viral diagnosis.
- Early and accurate identification of HAdV is essential to guide treatment, optimize management, and reduce unnecessary antibiotic prescriptions.
Purpose:
To compare the clinical severity of Human Adenovirus (HAdV) infection with other viral diseases in a cohort of children, evaluating presentation, therapy, and outcome.
Methods:
We conducted a retrospective multicenter cohort study in Italian children hospitalized from January to December 2023 for respiratory symptoms. The study included children with HAdV infection presenting primarily with respiratory symptoms. Patients with isolated gastrointestinal involvement or coinfection with bacteria were excluded.
Results:
A total of 171 children were enrolled: 98 with HAdV infection (age 44.3 ± 37.9 months) and 73 with other viruses (age 20.4 ± 27.2 months). In the first group, 57.1% had a coinfection with one or more additional viruses. The most common symptoms were fever (89.8%), cough (73.5%) and sore throat (52%). Respiratory distress and hypoxemia were more frequent in the non-HAdV group. Children with HAdV infection demonstrated significantly higher C-reactive protein levels (50.8 ± 54.2 vs. 16.5 ± 33.8 mg/L, p < 0.001), experienced a longer duration of fever (4.9 ± 3.6 vs. 3.4 ± 2.3 days, p = 0.009) and were more likely to receive antibiotic treatment (77.6% vs. 27.4%, p < 0.001). No differences were observed in hospitalization stay, rate of complications, and ICU admission.
Conclusions:
Interestingly, our data suggests that HAdV-infected children exhibit a more pronounced inflammatory response despite experiencing less severe respiratory symptoms compared to other viruses. The presence of prolonged fever and a strong inflammatory response often leads to antibiotic overuse during the initial phase, when the viral etiology is yet to be confirmed. Early and accurate identification of HAdV infection is crucial to optimize treatment strategies and minimize unnecessary antibiotic use.
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