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Observational Study
. 2016 Feb 12;11(2):e0146599.
doi: 10.1371/journal.pone.0146599. eCollection 2016.

Bacteremia in Children Hospitalized with Respiratory Syncytial Virus Infection

Miriam Cebey-López  1   2 , Jacobo Pardo-Seco  1   2   3 , Alberto Gómez-Carballa  1   2   3 , Nazareth Martinón-Torres  1   2 , José María Martinón-Sánchez  1   2 , Antonio Justicia-Grande  1   2 , Irene Rivero-Calle  1   2 , Elli Pinnock  4 , Antonio Salas  1   3 , Colin Fink  4 , Federico Martinón-Torres  1   2 ; GENDRES network
Affiliations
Observational Study

Bacteremia in Children Hospitalized with Respiratory Syncytial Virus Infection

Miriam Cebey-López et al. PLoS One. .

Abstract

Background: The risk of bacteremia is considered low in children with acute bronchiolitis. However the rate of occult bacteremia in infants with RSV infection is not well established. The aim was to determine the actual rate and predictive factors of bacteremia in children admitted to hospital due to confirmed RSV acute respiratory illness (ARI), using both conventional culture and molecular techniques.

Methods: A prospective multicenter study (GENDRES-network) was conducted between 2011-2013 in children under the age of two admitted to hospital because of an ARI. Among those RSV-positive, bacterial presence in blood was assessed using PCR for Meningococcus, Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus pyogenes, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, and Staphylococcus aureus, in addition to conventional cultures.

Results: 66 children with positive RSV respiratory illness were included. In 10.6% patients, bacterial presence was detected: H. influenzae (n = 4) and S. pneumoniae (n = 2). In those patients with bacteremia, there was a previous suspicion of bacterial superinfection and had received empirical antibiotic treatment 6 out of 7 (85.7%) patients. There were significant differences in terms of severity between children with positive bacterial PCR and those with negative results: PICU admission (100% vs. 50%, P-value = 0.015); respiratory support necessity (100% vs. 18.6%, P-value < 0.001); Wood-Downes score (mean = 8.7 vs. 4.8 points, P-value < 0.001); GENVIP scale (mean = 17 vs. 10.1, P-value < 0.001); and length of hospitalization (mean = 12.1 vs. 7.5 days, P-value = 0.007).

Conclusion: Bacteremia is not frequent in infants hospitalized with RSV respiratory infection, however, it should be considered in the most severe cases.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Severity parameters for the patients: Wood Downes score, GENVIP score, length of hospitalization, oxygen, respiratory support, respiratory distress and PICU admission.
Patients are classified as: positive RSV in nasopharyngeal sample, positive RSV with confirmed bacteremia, and positive RSV and suspected bacterial superinfection.
See this image and copyright information in PMC

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