Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH.
Pediatr Emerg Care. 2022 Jan 1;38(1):e398-e403. doi: 10.1097/PEC.0000000000002301.
Respiratory syncytial virus (RSV) in pediatric patients has been associated with low risk of concomitant bacterial infection. However, in children with severe disease, it occurs in 22% to 50% of patients. As viral testing becomes routine, bacterial codetections are increasingly identified in patients with non-RSV viruses. We hypothesized, among patients intubated for respiratory failure secondary to suspected infection, there are similar rates of codetection between RSV and non-RSV viral detections.
This retrospective chart review, conducted over a 5-year period, included all patients younger than 2 years who required intubation secondary to respiratory failure from an infectious etiology in a single pediatric emergency department. Patients intubated for noninfectious causes were excluded.
We reviewed 274 patients, of which 181 had positive viral testing. Of these, 48% were RSV-positive and 52% were positive for viruses other than RSV. Codetection of bacteria was found in 76% (n = 65; 95% confidence interval [CI], 66%, 84%) of RSV-positive patients and 66% (n = 63, 95% CI: 57%, 76%) of patients positive with non-RSV viruses. Among patients with negative viral testing, 33% had bacterial growth on lower respiratory culture. Male sex was the only patient-related factor associated with increased odds of codetection (odds ratio [OR], 2.2; 95% CI, 1.08-4.38). The odds of codetection between RSV-positive patients and non-RSV viruses were not significantly different (OR, 1.3; 95% CI, 0.62-2.71).
Bacterial codetection is common and not associated with anticipated patient-related factors or with a specific virus. These results suggest consideration of empiric antibiotics in infants with respiratory illness requiring intubation.
呼吸道合胞病毒（RSV）在儿科患者中与低风险的合并细菌感染相关。然而，在患有严重疾病的儿童中，22%至 50%的患者发生这种情况。随着病毒检测变得常规，在患有非 RSV 病毒的患者中越来越多地发现细菌共检测。我们假设，在因疑似感染而导致呼吸衰竭而插管的患者中，RSV 和非 RSV 病毒检测之间存在相似的共检测率。
这项回顾性图表研究在 5 年内进行，包括在一家儿科急诊部门，所有因感染性病因导致呼吸衰竭而需要插管的年龄小于 2 岁的患者。排除因非传染性原因而插管的患者。
我们回顾了 274 名患者，其中 181 名患者的病毒检测呈阳性。其中，48%为 RSV 阳性，52%为非 RSV 病毒阳性。在 RSV 阳性患者中，76%（n=65；95%置信区间[CI]：66%，84%）和非 RSV 病毒阳性患者中 66%（n=63，95%CI：57%，76%）发现细菌共检测。在病毒检测阴性的患者中，33%的下呼吸道培养物中有细菌生长。男性是唯一与增加共检测几率相关的患者相关因素（优势比[OR]，2.2；95%CI，1.08-4.38）。RSV 阳性患者和非 RSV 病毒之间的共检测几率没有显著差异（OR，1.3；95%CI，0.62-2.71）。
细菌共检测很常见，与预期的患者相关因素或特定病毒无关。这些结果表明，在需要插管的患有呼吸疾病的婴儿中，应考虑使用经验性抗生素。
