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Concurrent Serious Bacterial Infections in 2396 Infants and Children Hospitalized With Respiratory Syncytial Virus Lower Respiratory Tract Infections
Kevin Purcell, MD, PharmD, RPh;
Jaime Fergie, MD
Arch Pediatr Adolesc Med. 2002;156:322-324.
Background At Driscoll Children's Hospital (Corpus Christi, Tex), we observed that
most infants and children hospitalized for treatment of respiratory syncytial
virus (RSV) bronchiolitis and/or pneumonia received broad-spectrum intravenous
antibiotics despite having typical RSV signs and symptoms and positive RSV–rapid-antigen
tests on admission. Physicians were concerned about the possibility of concurrent
serious bacterial infections, especially in infants younger than 3 months
and in those with infiltrates present on the chest x-ray films.
Objective To report the frequency of concurrent serious bacterial infections in
infants and children hospitalized for treatment of RSV lower respiratory tract
infections.
Methods The medical records of 2396 infants and children admitted to Driscoll
Children's Hospital with RSV bronchiolitis and/or pneumonia during 7 RSV seasons
from July 1, 1991, through June 30, 1998, were reviewed.
Results There were positive cultures obtained from initial sepsis/meningitis
workups on admission in 39 infants and children (1.6%). Of these, 12 (31%)
were positive blood cultures and 27 (69%) were positive urine cultures. There
were no positive cerebrospinal fluid cultures. All of the positive blood cultures
contained either Staphylococcus epidermidis, Staphylococcus
warneri, or Bacillus species, which are common
contaminants. None of the patients received a standard 10-day course of intravenous
antibiotic therapy. All of the positive urine cultures were typical urinary
tract pathogens. All of the patients were treated.
Conclusions Concurrent serious bacterial infections are rare in infants and children
hospitalized with RSV lower respiratory tract infections and the empiric use
of broad-spectrum intravenous antibiotics is unnecessary in children with
typical signs and symptoms of RSV bronchiolitis.
From Texas A&M University–Kingsville School of Pharmacy,
Kingsville, Tex (Dr Purcell); Texas A&M University College of Medicine,
College Station (Dr Fergie); and the Driscoll Children's Hospital, Corpus
Christi, Tex (Dr Fergie).
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