RSV Pneumonia with or without bacterial co-infection among healthy children
Key Information:
Respiratory syncytial virus (RSV) is a leading cause of morbidity and mortality globally in preschool children with acute lower respiratory infections.
Current guidelines do not support the routine use of antibiotics in these children. However, higher incidence of bacterial co-infection with RSV bronchopulmonary infection was reported around 26.3–43.6%.
Bacterial pathogens had been detected in the respiratory secretions of children intubated for RSV infection, including Staphylococcus aureus, Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae.
The aim of this study was to find possible clinical difference between children infected with RSV alone or with bacterial co-infections.
In conclusion, nearly one-third of the pediatric inpatients with RSV pneumonia showed bacterial co-infection. Bacterial co-infection contributed longer hospital stay, more need of ventilator support, and more need of intensive care.
Therefore, physician should pay attention to bacterial coinfection in the management of pediatric inpatients with RSV bronchopulmonary infection.
For empirical antibacterial treatment, Amoxicillin-Clavulanic acid or Ampicillin-Sulbactam is recommended for non-critical cases whereas Vancomycin and Third-generation Cephalosporins may be used for critically ill patients requiring ICU care.
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Background
Respiratory syncytial virus (RSV) is a common cause of childhood pneumonia, but there is limited understanding of whether bacterial co-infections affect clinical severity.
Methods
We conducted a retrospective cohort study at National Taiwan University Hospital from 2010 to 2019 to compare clinical characteristics and outcomes between RSV with and without bacterial co-infection in children without underlying diseases, including length of hospital stay, intensive care unit (ICU) admission, ventilator use, and death.
Results
Among 620 inpatients with RSV pneumonia, the median age was 1.33 months (interquartile range, 0.67–2 years); 239 (38.6%) under 1 year old; 366 (59.0%) males; 201 (32.4%) co-infected with bacteria. The three most common bacteria are Streptococcus pneumoniae, Staphylococcus aureus and Haemophilus influenzae. The annually seasonal analysis showed that spring and autumn were peak seasons, and September was the peak month. Compared with single RSV infection, children with bacterial co-infection were younger, had longer hospital stay, needed more ICU care, had higher levels of C-reactive protein and more frequent hyponatremia. Overall, younger age, bacterial co-infection (especially S. aureus), thrombocytosis, and lower hemoglobin level were associated with the risk of requiring ICU care.
Conclusion
RSV related bacterial co-infections were not uncommon and assoicated with ICU admission, especially for young children, and more attention should be given. For empirical antibacterial treatment, high-dose amoxicillin-clavulanic acid or ampicillin-sulbactam was recommended for non-severe cases; vancomycin and third-generation cephalosporins were suggested for critically ill patients requiring ICU care.
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