Kim Minsung, Lee Jin, Han Seung Beom, Lee Soo Young
Department of Pediatrics, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
Department of Pediatrics, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea.
Eur J Pediatr. 2025 Jul 22;184(8):494. doi: 10.1007/s00431-025-06340-0.
Although acute bronchiolitis is primarily caused by viral infections, antibiotics are often administered to children with acute bronchiolitis. Due to concerns about serious bacterial infections (SBI), neonates and young infants are particularly prone to antibiotic overuse. This study aimed to identify the clinical characteristics and prevalence of SBI in neonates and infants aged < 90 days with acute bronchiolitis. We retrospectively reviewed the medical records of 651 neonates and infants aged < 90 days hospitalized with acute bronchiolitis between September 2015 and August 2024. Demographic and clinical data were analyzed to assess their clinical characteristics and the prevalence of SBI. Of the 651 infants, 230 (35.3%) had fever, and 485 (74.5%) received antibiotics. Blood cultures were performed in 646 (99.2%) infants; 52 (8.0%) yielded bacterial growth, but 50 were skin contaminants and one (Enterococcus faecium from an afebrile infant) was considered clinically insignificant. Only one (0.2%) infant had a probable true bacteremia caused by methicillin-susceptible Staphylococcus aureus. Among 621 (95.4%) infants who underwent urine cultures, seven (1.1%) had both bacteriuria and pyuria. Among them, only one (0.2%) infant had fever, which was deemed to have clinically significant urinary tract infection. Cerebrospinal fluid cultures in 31 infants were all negative.
SBI were rare in neonates and infants aged < 90 days hospitalized for acute bronchiolitis. This suggests that routine sepsis workups and empirical antibiotic therapy are not necessary for most of these patients. A selective approach to bacterial testing and antibiotic therapy is strongly justified.
•Empirical antibiotics are commonly used in infants aged ‹90 days with acute bronchiolitis due to concerns about concurrent serious bacterial infections.
•Serious bacterial infections are extremely rare in infants aged ‹90 days hospitalized with acute bronchiolitis, regardless of fever.
虽然急性细支气管炎主要由病毒感染引起，但急性细支气管炎患儿常使用抗生素。由于担心严重细菌感染（SBI），新生儿和小婴儿尤其容易出现抗生素过度使用的情况。本研究旨在确定年龄小于90天的急性细支气管炎新生儿和婴儿中SBI的临床特征和患病率。我们回顾性分析了2015年9月至2024年8月期间因急性细支气管炎住院的651例年龄小于90天的新生儿和婴儿的病历。分析人口统计学和临床数据以评估其临床特征和SBI的患病率。在这651例婴儿中，230例（35.3%）有发热，485例（74.5%）接受了抗生素治疗。646例（99.2%）婴儿进行了血培养；52例（8.0%）培养出细菌生长，但50例为皮肤污染物，1例（来自无发热婴儿的粪肠球菌）被认为临床意义不大。只有1例（0.2%）婴儿可能存在由甲氧西林敏感金黄色葡萄球菌引起的真正菌血症。在621例（95.4%）接受尿培养的婴儿中，7例（1.1%）有菌尿和脓尿。其中，只有1例（0.2%）婴儿有发热，被认为患有具有临床意义的尿路感染。31例婴儿的脑脊液培养均为阴性。
年龄小于90天因急性细支气管炎住院的新生儿和婴儿中SBI很少见。这表明对于大多数这些患者，常规败血症检查和经验性抗生素治疗没有必要。采用选择性细菌检测和抗生素治疗方法是非常合理的。
•由于担心并发严重细菌感染，经验性抗生素常用于年龄小于90天的急性细支气管炎婴儿。
•年龄小于90天因急性细支气管炎住院的婴儿中，严重细菌感染极其罕见，无论是否发热。
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