RESPIRATORY INFECTION

High incidence of pulmonary bacterial co-infection in children with severe respiratory syncytial virus (RSV) bronchiolitis

K Thorburn^1,2, S Harigopal¹, V Reddy¹, N Taylor², H K F van Saene²

¹ Department of Paediatric Intensive Care, Royal Liverpool Children’s Hospital, Liverpool, UK
² Department of Medical Microbiology, The University of Liverpool, Liverpool, UK

Correspondence to:
Dr K Thorburn
Department of Paediatric Intensive Care, Royal Liverpool Children’s Hospital, Liverpool L12 2AP, UK; kent.thorburn{at}rlc.nhs.uk

Background: Respiratory syncytial virus (RSV) is the most common cause of viral lower respiratory tract infections (LRTI). Viral LRTI is a risk factor for bacterial superinfection, having an escalating incidence with increasing severity of respiratory illness. A study was undertaken to determine the incidence of pulmonary bacterial co-infection in infants and children with severe RSV bronchiolitis, using paediatric intensive care unit (PICU) admission as a surrogate marker of severity, and to study the impact of the co-infection on morbidity and mortality.

Methods: A prospective microbiological analysis was made of lower airways secretions on all RSV positive bronchiolitis patients on admission to the PICU during three consecutive RSV seasons.

Results: One hundred and sixty five children (median age 1.6 months, IQR 0.5–4.6) admitted to the PICU with RSV bronchiolitis were enrolled in the study. Seventy (42.4%) had lower airway secretions positive for bacteria: 36 (21.8%) were co-infected and 34 (20.6%) had low bacterial growth/possible co-infection. All were mechanically ventilated (median 5.0 days, IQR 3.0–7.3). Those with bacterial co-infection required ventilatory support for longer than those with only RSV (p<0.01). White cell count, neutrophil count, and C-reactive protein did not differentiate between the groups. Seventy four children (45%) received antibiotics prior to intubation. Sex, co-morbidity, origin, prior antibiotics, time on preceding antibiotics, admission oxygen, and ventilation index were not predictive of positive bacterial cultures. There were 12 deaths (6.6%), five of which were related to RSV.

Conclusions: Up to 40% of children with severe RSV bronchiolitis requiring admission to the PICU were infected with bacteria in their lower airways and were at increased risk for bacterial pneumonia.

Abbreviations: BAL, bronchoalveolar lavage; LRTI, lower respiratory tract infection; PICU, paediatric intensive care unit; RSV, respiratory syncytial virus

Keywords: respiratory syncytial virus; bronchiolitis; bacterial co-infection; children; paediatric intensive care

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