Bacteremia in Children Hospitalized Due to Respiratory Syncytial Virus Infection
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The frequency of bacteremia in children hospitalized due to respiratory syncytial virus infection (RSV) rarely exceeds 1%, but a recent study reported a 10% risk of bacteremia. In this study, we set out to verify the frequency, usefulness, and costs of blood cultures in RSV infections. We addressed the issue by reviewing medical files of 512 children, aged 8 days–121 months, who were hospitalized during January 2010 and June 2017. The RSV-related diagnoses included bronchiolitis (390 patients), RSV pneumonia (65 patients), and bronchitis (57 patients). There were 212 blood cultures performed in 185 patients (36%). In 10 cultures (5.4%), the following pathogens were identified: Staphylococcus haemolyticus, 4; Staphylococcus epidermidis, 1; Staphylococcus hominis, 1; Corynebacterium, 1 Streptococcus parasanguinis, 1; Rothia mucilaginosa, 1; Micrococcus luteus, 1; and Streptococcus hominis, 1 case. However, all of these pathogens were identified as a contamination of samples only. Therefore, both positive blood cultures turned out in fact negative, and the patients having either result of blood culturing showed no clinically relevant differences. The total cost of blood cultures in the pediatric ward amounted to €1980. If performed in each and every patient, the costs would have reached €5490. In conclusion, the frank frequency of bacteremia in children with RSV infection, with no sepsis, seems exceedingly low, which confirms the earlier findings. Thus, blood culturing, generating high costs, is of negligible clinical value. The study provides no evidence supporting a routine blood culture in case of children hospitalized due to RSV infection.
KeywordsBacteremia Bronchiolitis Children Procalcitonin Respiratory infection Respiratory syncytial virus Septicemia
This study was supported by CMKP grant number 501-1-020-19-19.
Conflict of Interest
The authors declare no conflict of interest in relation to this article.
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 was approved by the Ethics Committee of the Center of Postgraduate Medical Education in Warsaw, Poland.
Informed consent was obtained from all individual participants included in the study.
- Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, Kaplan SL, Mace SE, GH MC Jr, Moore MR, St Peter SD, Stockwell JA, Swanson JT, Pediatric Infectious Diseases Society and the Infectious Diseases Society of America (2011) The management of community–acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis 53:e25–e76CrossRefGoogle Scholar
- 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
- 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
- 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
- Hall CB, Weinberg GA, Blumkin AK, Edwards KM, Staat MA, Schultz AF, Poehling KA, Szilagyi PG, Griffin MR, Williams JV, Zhu Y, Grijalva CG, Prill MM, Iwane MK (2013) Respiratory syncytial virus–associated hospitalizations among children less than 24 months of age. Pediatrics 132:e341–e348CrossRefGoogle Scholar
- Kneyber MC, van Woensel JB, Uijtendaal E, Uiterwaal CS, Kimpen JL, Dutch Antibiotics in RSV Trial (DART) Research Group (2008) Azithromycin does not improve disease course in hospitalized infants with respiratory syncytial virus (RSV) lower respiratory tract disease: a randomized equivalence trial. Pediatr Pulmonol 43:142–149CrossRefGoogle Scholar
- 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
- Pinto LA, Pitrez PM, Luisi F, de Mello PP, Gerhardt M, Ferlini R, Barbosa DC, Daros I, Jones MH, Stein RT, Marostica PJ (2012) Azithromycin therapy in hospitalized infants with acute bronchiolitis is not associated with better clinical outcomes: a randomized, double–blinded, and placebo–controlled clinical trial. J Pediatr 161:1104–1108CrossRefGoogle Scholar
- 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
- Suárez-Arrabal MC, Mella C, Lopez SM, Brown NV, Hall MW, Hammond S, Shiels W, Groner J, Marcon M, Ramilo O, Mejias A (2015) Nasopharyngeal bacterial burden and antibiotics: influence on inflammatory markers and disease severity in infants with respiratory syncytial virus bronchiolitis. J Infect 71:458–469CrossRefGoogle Scholar
- Wu A, Budge PJ, Williams J, Griffin MR, Edwards KM, Johnson M, Zhu Y, Hartinger S, Verastegui H, Gil AI, Lanata CF, Grijalva CG (2015) Incidence and risk factors for respiratory syncytial virus and human metapneumovirus infections among children in the remote highlands of Peru. PLoS One 10(6):e0130233CrossRefGoogle Scholar