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Antibiotic Treatment in Patients with Bronchiolitis

  • August Wrotek
  • Małgorzata Czajkowska
  • Teresa JackowskaEmail author
Chapter
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1211)

Abstract

This study seeks to define the indications and the economic impact of the use of antibiotics in infants hospitalized due to bronchiolitis during 2010–2017. There were 459 children with bronchiolitis, median age of 2.2 months, 390 infections with respiratory syncytial virus (RSV), and 69 were non-RSV. Twenty two percent of all these children (102/459) required a workup toward urinary tract co-infections (UTI). A control group, consisting of 8,456 children without bronchiolitis, was created to assess UTI frequency in the general population. We found that 16.0% (73/459) children with bronchiolitis received antibiotics; 63 (13.7%) due to respiratory infection and 9 due to UTI. A time-trend analysis showed a decreasing use of antibiotics, from 57.0% in 2010 to 13.7% in 2017, with the lowest value of 6.4% noticed in 2014. Children treated with antibiotics required a 4-day longer hospitalization than those untreated (p < 0.01), but there were no other clinically relevant differences. After excluding the first 2 years with the highest antibiotic ordering, antibiotics, on average, were used in 9.8% of children with bronchiolitis. Frequency of UTI accompanying bronchiolitis was comparable to that in the control group (8.9% vs. 10.9%, respectively). Specificity of urine culture was 71%, with 100% sensitivity assumed, while the positive predicted value of only 41%. The unnecessary costs of urine cultures, if performed in each patient, would have been €2,236, and with additional laboratory tests in each case of a false positive result it would have reached €5,448. We conclude that antibiotics should be used for bronchiolitis only in justified cases, and their use should not exceed 10% of patients. Since UTI is no more frequent in bronchiolitis than in the general children’s population, urine cultures should not be performed routinely.

Keywords

Antibiotics Bronchiolitis Children Infection Respiratory syncytial virus Urinary tract infection Urine culture 

Notes

Acknowledgments

This work was supported by CMKP grant 506-1-20-19-17.

Conflicts of Interest

The authors declare no conflicts of interest in relation to this article.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol was approved by an institutional Ethics Committee.

Informed Consent

This was a retrospective study; thus, the requirement of obtaining consent from individual participants was waived.

References

  1. Ampofo K, Bender J, Sheng X, Korgenski K, Daly J, Pavia AT, Byington CL (2008) Seasonal invasive pneumococcal disease in children: role of preceding respiratory viral infection. Pediatrics 122:229–237CrossRefGoogle Scholar
  2. Andrade MA, Hoberman A, Glustein J, Paradise JL, Wald ER (1998) Acute otitis media in children with bronchiolitis. Pediatrics 101:617–619CrossRefGoogle Scholar
  3. Baraldi E, Lanari M, Manzoni P, Rossi GA, Vandini S, Rimini A, Romagnoli C, Colonna P, Biondi A, Biban P, Chiamenti G, Bernardini R, Picca M, Cappa M, Magazzù G, Catassi C, Urbino AF, Memo L, Donzelli G, Minetti C, Paravati F, Di Mauro G, Festini F, Esposito S, Corsello G (2014) Inter-society consensus document on treatment and prevention of bronchiolitis in newborns and infants. Ital J Pediatr 40:65CrossRefGoogle Scholar
  4. Breakell R, Thorndyke B, Clennett J, Harkensee C (2018) Reducing unnecessary chest X-rays, antibiotics and bronchodilators through implementation of the NICE bronchiolitis guideline. Eur J Pediatr 177:47–51CrossRefGoogle Scholar
  5. Cebey-López M, Pardo-Seco J, Gómez-Carballa A, Martinón-Torres N, Martinón-Sánchez JM, Justicia-Grande A, Rivero-Calle I, Pinnock E, Salas A, Fink C, Martinón-Torres F, GENDRES network (2016) Bacteremia in children hospitalized with respiratory syncytial virus infection. PLoS One 11:e0146599CrossRefGoogle Scholar
  6. Christakis DA, Cowan CA, Garrison MM, Molteni R, Marcuse E, Zerr DM (2005) Variation in inpatient diagnostic testing and management of bronchiolitis. Pediatrics 115:878–884CrossRefGoogle Scholar
  7. Elkhunovich MA, Wang VJ (2015) Assessing the utility of urine testing in febrile infants aged 2 to 12 months with bronchiolitis. Pediatr Emerg Care 31:616–620CrossRefGoogle Scholar
  8. Farley R, Spurling GK, Eriksson L, Del Mar CB (2014) Antibiotics for bronchiolitis in children under two years of age. Cochrane Database Syst Rev 10:CD005189Google Scholar
  9. Flores-González JC, Mayordomo-Colunga J, Jordan I, Miras-Veiga A, Montero-Valladares C, Olmedilla-Jodar M, Alcaraz-Romero AJ, Eizmendi-Bereciartua M, Fernández-Carrión F, Santiago-Gutierrez C, Aleo-Luján E, Pérez-Quesada S, Yun-Castilla C, Martín C, Navarro-Mingorance Á, Goñi-Orayen C (2017) Prospective multicentre study on the epidemiology and current therapeutic management of severe bronchiolitis in Spain. Biomed Res Int 2017:2565397CrossRefGoogle Scholar
  10. Friedman JN, Rieder MJ, Walton JM, Canadian Paediatric Society, Acute Care Committee, Drug Therapy and Hazardous Substances Committee (2014) Bronchiolitis: recommendations for diagnosis, monitoring and management of children one to 24 months of age. Paediatr Child Health 19:485–498CrossRefGoogle Scholar
  11. Genies MC, Kim JM, Pyclik K, Rossi S, Spicyn N, Serwint JR (2018) Impact of an educational intervention to improve physician adherence to bronchiolitis clinical practice guidelines: a pre-post intervention study. Clin Pediatr (Phila) 57:253–258CrossRefGoogle Scholar
  12. Gomaa MA, Galal O, Mahmoud MS (2012) Risk of acute otitis media in relation to acute bronchiolitis in children. Int J Pediatr Otorhinolaryngol 76:49–51CrossRefGoogle Scholar
  13. Greenes DS, Harper MB (1999) Low risk of bacteremia in febrile children with recognizable viral syndromes. Pediatr Infect Dis J 18:258–261CrossRefGoogle Scholar
  14. Hall CB, Powell KR, Schnabel KC, Gala CL, Pincus PH (1988) Risk of secondary bacterial infection in infants hospitalized with respiratory syncytial viral infection. J Pediatr 113:266–271CrossRefGoogle Scholar
  15. Hament JM, Aerts PC, Fleer A, Van Dijk H, Harmsen T, Kimpen JL, Wolfs TF (2004) Enhanced adherence of Streptococcus pneumoniae to human epithelial cells infected with respiratory syncytial virus. Pediatr Res 55:972–978CrossRefGoogle Scholar
  16. Hollingworth W, Busby J, Butler CC, O’Brien K, Sterne JA, Hood K, Little P, Lawton M, Birnie K, Thomas-Jones E, Harman K, Hay AD, Study Team DUTY (2017) The diagnosis of urinary tract infection in young children (DUTY) study clinical rule: economic evaluation. Value Health 20:556–566CrossRefGoogle Scholar
  17. Kabir ML, Haq N, Hoque M, Ahmed F, Amin R, Hossain A, Khatoon S, Akhter S, Shilpi T, Haq R, Anisuzzaman S, Khan MH, Ahamed S, Khashru A (2003) Evaluation of hospitalized infants and young children with bronchiolitis – a multi centre study. Mymensingh Med J 12:128–133PubMedGoogle Scholar
  18. Kneyber MC, Blussé van Oud-Alblas H, van Vliet M, Uiterwaal CS, Kimpen JL, van Vught AJ (2005) Concurrent bacterial infection and prolonged mechanical ventilation in infants with respiratory syncytial virus lower respiratory tract disease. Intensive Care Med 31:680–685CrossRefGoogle Scholar
  19. Levine DA, Platt SL, Dayan PS, Macias CG, Zorc JJ, Krief W, Schor J, Bank D, Fefferman N, Shaw KN, Kuppermann N, Multicenter RSV-SBI Study Group of the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics (2004) Risk of serious bacterial infection in young febrile infants with respiratory syncytial virus infections. Pediatrics 113:1728–1734CrossRefGoogle Scholar
  20. Luginbuhl LM, Newman TB, Pantell RH, Finch SA, Wasserman RC (2008) Office-based treatment and outcomes for febrile infants with clinically diagnosed bronchiolitis. Pediatrics 122:947–954CrossRefGoogle Scholar
  21. Madhi SA, Klugman KP, Vaccine Trialist Group (2004) A role for Streptococcus pneumoniae in virus-associated pneumonia. Nat Med 10:811–813CrossRefGoogle Scholar
  22. McGillivary G, Mason KM, Jurcisek JA, Peeples ME, Bakaletz LO (2009) Respiratory syncytial virus-induced dysregulation of expression of a mucosal beta-defensinaugments colonization of the upper airway by non-typeable Haemophilus influenzae. Cell Microbiol 11:1399–1408CrossRefGoogle Scholar
  23. Murphy TF, Bakaletz LO, Smeesters PR (2009) Microbial interactions in the respiratory tract. Pediatr Infect Dis J 28:S121–S126CrossRefGoogle Scholar
  24. Nair H, Nokes DJ, Gessner BD, Dherani M, Madhi SA, Singleton RJ, O’Brien KL, Roca A, Wright PF, Bruce N, Chandran A, Theodoratou E, Sutanto A, Sedyaningsih ER, Ngama M, Munywoki PK, Kartasasmita C, Simões EA, Rudan I, Weber MW, Campbell H (2010) Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet 375:1545–1555CrossRefGoogle Scholar
  25. Parikh K, Hall M, Mittal V, Montalbano A, Mussman GM, Morse RB, Hain P, Wilson KM, Shah SS (2014) Establishing benchmarks for the hospitalized care of children with asthma, bronchiolitis, and pneumonia. Pediatrics 134:555–562CrossRefGoogle Scholar
  26. Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM, Johnson DW, Light MJ, Maraqa NF, Mendonca EA, Phelan KJ, Zorc JJ, Stanko-Lopp D, Brown MA, Nathanson I, Rosenblum E, Sayles S 3rd, Hernandez-Cancio S, American Academy of Pediatrics (2014) Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics 134:e1474–e1502CrossRefGoogle Scholar
  27. Ramagopal G, Brow E, Mannu A, Vasudevan J, Umadevi L (2016) Demographic, clinical and hematological profile of children with bronchiolitis: a comparative study between respiratory synctial virus (RSV) and (Non RSV) groups. J Clin Diagn Res 10:SC05–SC08PubMedPubMedCentralGoogle Scholar
  28. Shazberg G, Revel-Vilk S, Shoseyov D, BenAmi A, Klar A, Hurvitz H (2000) The clinical course of bronchiolitis associated with acute otitis media. Arch Dis Child 83:317–319CrossRefGoogle Scholar
  29. Stollar F, Alcoba G, Gervaix A, Argiroffo CB (2014) Virologic testing in bronchiolitis: does it change management decisions and predict outcomes? Eur J Pediatr 173:1429–1435CrossRefGoogle Scholar
  30. Talbot TR, Poehling KA, Hartert TV, Arbogast PG, Halasa NB, Edwards KM, Schaffner W, Craig AS, Griffin MR (2005) Seasonality of invasive pneumococcal disease: temporal relation to documented influenza and respiratory syncytial virus circulation. Am J Med 118:285–291CrossRefGoogle Scholar
  31. Techasaensiri B, Techasaensiri C, Mejías A, McCracken GH Jr, Ramilo O (2010) Viral coinfections in children with invasive pneumococcal disease. Pediatr Infect Dis J 29:519–523PubMedGoogle Scholar
  32. Thorburn K, Harigopal S, Reddy V, Taylor N, van Saene HK (2006) High incidence of pulmonary bacterial co-infection in children with severe respiratory syncytial virus (RSV) bronchiolitis. Thorax 61:611–615CrossRefGoogle Scholar
  33. Titus MO, Wright SW (2003) Prevalence of serious bacterial infections in febrile infants with respiratory syncytial virus infection. Pediatrics 112:282–284CrossRefGoogle Scholar
  34. Vogel AM, Lennon DR, Harding JE, Pinnock RE, Graham DA, Grimwood K, Pattemore PK (2003) Variations in bronchiolitis management between five New Zealand hospitals: can we do better? J Paediatr Child Health 39:40–45CrossRefGoogle Scholar
  35. Weinberger DM, Givon-Lavi N, Shemer-Avni Y, Bar-Ziv J, Alonso WJ, Greenberg D, Dagan R (2013) Influence of pneumococcal vaccines and respiratory syncytial virus on alveolar pneumonia, Israel. Emerg Infect Dis 19:1084–1091CrossRefGoogle Scholar
  36. Weinberger DM, Klugman KP, Steiner CA, Simonsen L, Viboud C (2015) Association between respiratory syncytial virus activity and pneumococcal disease in infants: a time series analysis of US hospitalization data. PLoS Med 12:e1001776CrossRefGoogle Scholar
  37. Zurowska A (2012) Recommendations of the Polish Society of Pediatric Nephrology (PTNFD) for dealing with a child with urinary tract infection. https://ptnfd.org/wp-content/uploads/2012/07/Zalecenia-PTND.pdf. Accessed on 20 Mar 2018

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • August Wrotek
    • 1
    • 2
  • Małgorzata Czajkowska
    • 1
    • 2
  • Teresa Jackowska
    • 1
    • 2
    Email author
  1. 1.Department of PediatricsCenter of Postgraduate Medical EducationWarsawPoland
  2. 2.Department of PediatricsBielanski HospitalWarsawPoland

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