Risk factors for concomitant bacterial infection in critically ill infants with bronchiolitis
CCCF ePoster library. Maratta C. 11/12/19; 283425; EP75
Dr. Christina Maratta
Dr. Christina Maratta
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Topic: Retrospective or Prospective Cohort Study or Case Series

Maratta, Christina1Noël, Kim C.2; Aljassim, Nada3; Tam, Ingrid4; Papenburg, Jesse5; Quach, Caroline6; Thampi, Nisha7; Dendukuri, Nandini2; O'Donnell, Shauna8; Fontela, Patricia S.2,9

1Pediatric Critical Care, Hospital for Sick Children, Toronto, Canada; 2Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada; 3King Fahad Medical City, Riyadh, Saudi Arabia;  4Faculty of Medicine, University of Limerick, Limerick, Ireland; 5Division of Pediatric Infectious Diseases, Department of Pediatrics, McGill University, Montreal, Canada; 6Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montreal, Canada; 7Department of Pediatrics, University of Ottawa, Ottawa, Canada; 8Research Institute of the McGill University Health Centre, Montreal, Canada; 9Department of Pediatrics, McGill University, Montreal, Canada

BACKGROUND: Bronchiolitis is a very common lower respiratory tract infection among infants.1 While it is mostly caused by respiratory syncytial virus, antibiotics are frequently used due to the risk of having a concomitant bacterial infection.2 However, studies show that rates of bacterial coinfection in bronchiolitis patients are low, ranging between 7-12%.2,3 Identifying risk factors associated with having a concomitant bacterial infection could help to optimize antibiotic use in this patient population, while reducing the inappropriate use of these agents and, consequently,  bacterial resistance in the hospital setting.
OBJECTIVES: We aimed to 1) determine the incidence rate of a concomitant bacterial infection, and 2) describe the risk factors associated with a concomitant bacterial infection in critically ill infants with bronchiolitis.
METHODS: A retrospective cohort study of children <2 years old admitted to pediatric intensive care units at the Montreal Children's Hospital (MCH), the Centre Hospitalier Universitaire de Sainte Justine (CHUSJ), or the Children's Hospital of Eastern Ontario (CHEO) over 2 winter seasons (2016-2017 and 2017-2018). We analyzed data using descriptive statistics, Chi-squared test, and multivariable logistic regression.
RESULTS: 372 patients were included in the study. Mean age was 4.8±5.3 months. A total of 244 (66%) patients were prescribed antibiotics, and the median duration of antibiotics was 4.0 days (interquartile range [IQR] 2.0 – 8.0). The proportion of patients who had a viral infection only was 270 (76%). Of these patients, 146 (64%) patients were prescribed antibiotics, with a median duration of 3 days (IQR 2 – 6.8), and 67 (25%) patients received a full course (≥7) of antibiotics. The proportion of patients with a clinical diagnosis for a bacterial infection was 87 (24%), ranging from 25 (MCH, 14%) to 23 (CHEO, 43%) patients. Our regression analyses showed that CHUSJ (OR 0.39, 95% confidence interval [CI] 0.17, 0.88; reference group: MCH) and need for positive pressure ventilation (OR 3.09, 95%CI 1.42, 7.06) were associated with having a clinical diagnosis of bacterial coinfection.
CONCLUSION: Antibiotics are frequently used in critically ill infants with a purely viral bronchiolitis. Our study showed that need for positive pressure ventilation is a risk factor for having a concomitant bacterial infection. The development of antimicrobial stewardship interventions can help to target bronchiolitis patients with a high risk of bacterial coinfection to reduce antibiotic overuse in this patient population.

1. Shi T, McAllister DA, O'Brien KL, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. The Lancet;390:946-58.
2. Papenburg J, Fontela PS, Freitas RR, Burstein B. Inappropriate Antibiotic Prescribing for Acute Bronchiolitis in US Emergency Departments, 2007–2015. Journal of the Pediatric Infectious Diseases Society 2019.
3. Levine DA, Platt SL, Dayan PS, et al. Risk of Serious Bacterial Infection in Young Febrile Infants With Respiratory Syncytial Virus Infections. 2004;113:1728-34.
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