Pediatric Intensive Care Unit, Emma Children's Hospital, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Department of Medical Microbiology, Academic Medical Center, Amsterdam, The Netherlands.
BMC Infect Dis. 2019 Nov 6;19(1):938. doi: 10.1186/s12879-019-4468-3.
Viral bronchiolitis is the most common cause of respiratory failure requiring invasive ventilation in young children. Bacterial co-infections may complicate and prolong paediatric intensive care unit (PICU) stay. Data on prevalence, type of pathogens and its association with disease severity are limited though. These data are especially important as bacterial co-infections may be treated using antibiotics and could reduce disease severity and duration of PICU stay. We investigated prevalence of bacterial co-infection and its association with disease severity and PICU stay.
Retrospective cohort study of the prevalence and type of bacterial co-infections in ventilated children performed in a 14-bed tertiary care PICU in The Netherlands. Children less than 2 years of age admitted between December 2006 and November 2014 with a diagnosis of bronchiolitis and requiring invasive mechanical ventilation were included. Tracheal aspirates (TA) and broncho-alveolar lavages (BAL) were cultured and scored based on the quantity of bacteria colony forming units (CFU) as: co-infection (TA > 10/BAL > 10 CFU), low bacterial growth (TA < 10/BAL < 10 CFU), or negative (no growth). Duration of mechanical ventilation and PICU stay were collected using medical records and compared against the presence of co-infection using univariate and multivariate analysis.
Of 167 included children 63 (37.7%) had a bacterial co-infection and 67 (40.1%) low bacterial growth. Co-infections occurred within 48 h from intubation in 52 out 63 (82.5%) co-infections. H.influenza (40.0%), S.pneumoniae (27.1%), M.catarrhalis (22.4%), and S.aureus (7.1%) were the most common pathogens. PICU stay and mechanical ventilation lasted longer in children with co-infections than children with negative cultures (9.1 vs 7.7 days, p = 0.04 and 8.1vs 6.5 days, p = 0.02).
In this large study, bacterial co-infections occurred in more than a third of children requiring invasive ventilation for bronchiolitis and were associated with longer PICU stay and mechanical ventilation. These findings support a clinical trial of antibiotics to test whether antibiotics can reduce duration of PICU stay.
病毒性细支气管炎是导致婴幼儿需要接受有创通气的最常见的呼吸衰竭病因。细菌合并感染可能会使儿科重症监护病房（PICU）的住院时间延长并复杂化。然而，有关其患病率、病原体类型及其与疾病严重程度的关联的数据有限。由于细菌合并感染可能需要使用抗生素进行治疗，并且可以减轻疾病严重程度和缩短 PICU 住院时间，因此这些数据非常重要。我们研究了细菌合并感染的患病率及其与疾病严重程度和 PICU 住院时间的关系。
这是一项在荷兰一家 14 床的三级护理 PICU 中进行的、针对有创通气患儿中细菌合并感染的患病率和类型的回顾性队列研究。研究纳入了 2006 年 12 月至 2014 年 11 月期间因细支气管炎且需要有创机械通气而入院且年龄小于 2 岁的患儿。对气管吸出物（TA）和支气管肺泡灌洗液（BAL）进行培养，并根据细菌菌落形成单位（CFU）的数量进行评分：合并感染（TA>10/BAL>10 CFU）、低度细菌生长（TA<10/BAL<10 CFU）或阴性（无生长）。使用病历收集机械通气和 PICU 住院时间，并通过单变量和多变量分析比较合并感染的存在情况。
在 167 例纳入的患儿中，63 例（37.7%）存在细菌合并感染，67 例（40.1%）存在低度细菌生长。52 例（82.5%）合并感染发生在插管后 48 小时内。最常见的病原体是流感嗜血杆菌（40.0%）、肺炎链球菌（27.1%）、卡他莫拉菌（22.4%）和金黄色葡萄球菌（7.1%）。与培养阴性的患儿相比，合并感染患儿的 PICU 住院时间和机械通气时间更长（9.1 天 vs 7.7 天，p=0.04；8.1 天 vs 6.5 天，p=0.02）。
在这项大型研究中，需要接受有创通气治疗的细支气管炎患儿中超过三分之一存在细菌合并感染，并且与 PICU 住院时间延长和机械通气时间延长有关。这些发现支持进行抗生素临床试验，以测试抗生素是否可以缩短 PICU 住院时间。
