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High incidence of pulmonary bacterial co-infection in children with severe respiratory syncytial virus (RSV) bronchiolitis
  1. K Thorburn1,2,
  2. S Harigopal1,
  3. V Reddy1,
  4. N Taylor2,
  5. H K F van Saene2
  1. 1Department of Paediatric Intensive Care, Royal Liverpool Children’s Hospital, Liverpool, UK
  2. 2Department of Medical Microbiology, The University of Liverpool, Liverpool, UK
  1. Correspondence to:
    Dr K Thorburn
    Department of Paediatric Intensive Care, Royal Liverpool Children’s Hospital, Liverpool L12 2AP, UK; kent.thorburn{at}


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.

  • BAL, bronchoalveolar lavage
  • LRTI, lower respiratory tract infection
  • PICU, paediatric intensive care unit
  • RSV, respiratory syncytial virus
  • respiratory syncytial virus
  • bronchiolitis
  • bacterial co-infection
  • children
  • paediatric intensive care

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  • Published Online First 14 March 2006

  • Funding: none.

  • The authors have no financial or ethical conflicts of interest or any other competing interests with regard to the contents of this manuscript.

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