Concurrent bacterial infection and prolonged mechanical ventilation in infants with respiratory syncytial virus lower respiratory tract disease

被引:67
作者
Kneyber, MCJ
van Oud-Alblas, HB
van Vliet, M
Uiterwaal, CSPM
Kimpen, JLL
van Vught, AJ
机构
[1] Vrije Univ Amsterdam Med Ctr, Dept Pediat Intens Care, NL-1007 MB Amsterdam, Netherlands
[2] Univ Med Ctr, Wilhelmina Childrens Hosp, Dept Pediat, Utrecht, Netherlands
[3] Univ Med Ctr, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands
关键词
respiratory syncytial virus; mechanical ventilation; antibiotics; concurrent bacterial infection; infants;
D O I
10.1007/s00134-005-2614-4
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: To identify demographic, clinical, and laboratory variables predictive for a concurrent bacterial pulmonary infection in ventilated infants with respiratory syncytial virus (RSV) lower respiratory tract disease (LRTD) and investigate antimicrobial drug use. Design and setting: Retrospective, observational study in a 14-bed pediatric intensive care unit. Patients: 82 infants younger than 1 year of age with a virologically confirmed RSV LRTD during 1996-2001, of whom 65 were mechanically ventilated. Results: Microbiological data were available from 38 ventilated infants, 10 of whom had a positive blood culture (n=1) or endotracheal aspirate (n=9) obtained upon admission to the pediatric intensive care unit (PICU). Infants with a positive culture had a lower mean gestational age but were otherwise demographically comparable to those with negative culture results. Infants with a positive culture were ventilated 4 days longer. Indicators for a concurrent bacterial infection were comparable between ventilated and nonventilated infants. Antimicrobial drugs were used in 95.1% of infants (100% of ventilated infants) with a mean duration of 7.8 +/- 0.3 days. The moment of initiation and duration of antimicrobial drug treatment varied considerably. Conclusions: We observed in ventilated infants a low occurrence of concurrent bacterial pulmonary infection, but infants with positive cultures needed prolonged ventilatory support. Improvement in the diagnosis of a pulmonary bacterial infection is warranted to reduce the overuse of antimicrobial drugs among ventilated infants with RSV LRTD and to restrict these drugs to the proper patients.
引用
收藏
页码:680 / 685
页数:6
相关论文
共 30 条
[1]   Sepsis evaluations in hospitalized infants with bronchiolitis [J].
Antonow, JA ;
Hansen, K ;
McKinstry, CA ;
Byington, CL .
PEDIATRIC INFECTIOUS DISEASE JOURNAL, 1998, 17 (03) :231-236
[2]   International variation in the management of infants hospitalized with respiratory syncytial virus [J].
Behrendt, CE ;
Decker, MD ;
Burch, DJ ;
Watson, PH .
EUROPEAN JOURNAL OF PEDIATRICS, 1998, 157 (03) :215-220
[3]   Differences in management of bronchiolitis between hospitals in The Netherlands [J].
Brand, PLP ;
Vaessen-Verberne, AAPH .
EUROPEAN JOURNAL OF PEDIATRICS, 2000, 159 (05) :343-347
[4]  
CHESNEY PJ, 2003, PRINCIPLES PRACTICE, P694
[5]   THE RESPIRATORY SYNCTIAL VIRUS AND ITS ROLE IN ACUTE BRONCHIOLITIS [J].
EVERARD, ML ;
MILNER, AD .
EUROPEAN JOURNAL OF PEDIATRICS, 1992, 151 (09) :638-651
[6]   The presence and sequence of endotracheal tube colonization in patients undergoing mechanical ventilation [J].
Feldman, C ;
Kassel, M ;
Cantrell, J ;
Kaka, S ;
Morar, R ;
Mahomed, AG ;
Philips, JI .
EUROPEAN RESPIRATORY JOURNAL, 1999, 13 (03) :546-551
[7]   ANTIBIOTIC-TREATMENT OF PNEUMONIA AND BRONCHIOLITIS - A PROSPECTIVE RANDOMIZED STUDY [J].
FRIIS, B ;
ANDERSEN, P ;
BRENOE, E ;
HORNSLETH, A ;
JENSEN, A ;
KNUDSEN, FU ;
KRASILNIKOFF, PA ;
MORDHORST, CH ;
NIELSEN, S ;
ULDALL, P .
ARCHIVES OF DISEASE IN CHILDHOOD, 1984, 59 (11) :1038-1045
[8]   Reproducibility of blind protected bronchoalveolar lavage in mechanically ventilated children [J].
Gauvin, F ;
Lacroix, J ;
Guertin, MC ;
Proulx, F ;
Farrell, CA ;
Moghrabi, A ;
Lebel, P ;
Dassa, C .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2002, 165 (12) :1618-1623
[9]   Low risk of bacteremia in febrile children with recognizable viral syndromes [J].
Greenes, DS ;
Harper, MB .
PEDIATRIC INFECTIOUS DISEASE JOURNAL, 1999, 18 (03) :258-261
[10]  
HALL CB, 1988, J PEDIATR-US, V113, P266