Does Coinfection Lead to Longer Ventilation Times?

Does Coinfection Lead to Longer Ventilation Times? 1024 683 Pam Georgiana

New multicenter study evaluates treatments and diagnoses of respiratory infections in young patients. 

 

Lower respiratory tract infection, or bronchiolitis, is one of the most common reasons for intensive care unit (ICU) admissions and mechanical ventilation in children younger than two years old. Despite this, little current research exists regarding the most effective treatment when the viral infection is paired with a bacterial infection.

Todd J. Karsies, MD, a critical care physician at Nationwide Children’s and a clinical associate professor of Pediatrics for The Ohio State University College of Medicine, initiated a collaborative effort to build a bank of current research for the treatment of respiratory infections in the ICU. When he and his team proposed the idea to other PICUs in the Pediatric Acute Lung Injury and Sepsis Investigators Network, the response was overwhelmingly positive: 47 PICUs in 12 North and South American countries with a wide income range participated in the observational study. The results were recently published in Pediatrics Critical Care Medicine.

The team chose to study bacterial codetection in infants intubated for acute lower respiratory infection. Codetection is defined as a heavy bacterial growth plus evidence of inflammation on a respiratory culture. Secondarily, the team decided to measure how codetection impacted the duration of invasive mechanical ventilation.

“The traditional expectation is that bacterial codetections are rare in bronchiolitis but when present, make patients sicker and, as a result, we would expect them to need a longer ventilation period,” Dr. Karsies explains. “However, with increased use of noninvasive ventilation and recent studies suggesting that antibiotics might improve outcomes for some with bronchiolitis, we wondered if this would still hold true.”

The team analyzed the charts of 472 patients in total. 55% had a positive respiratory culture, 29% had codetection, and almost all (90%) patients received early antibiotics. The median ventilation duration was 151 hours.

Dr. Karsies and the team concluded that codetection was not associated with a longer ventilation duration. Further studies are needed to confirm whether codetection is indeed associated with a shorter ventilation duration, which could lead to more targeted and effective treatment.

“We also had some unexpected findings,” Dr. Karsies says, “For example, when we looked at diagnosis at admission, patients diagnosed with bronchiolitis more often had bacterial codetection. In contrast, codetection was uncommon when the admitting diagnosis was pneumonia—a disease commonly felt to be bacterial. That led us to conclude that we need a better diagnostic definition of true bacterial infection in the setting of viral bronchiolitis.”

There is also a pressing need for further research to determine the appropriate use of antibiotics in this vulnerable patient population. While past studies focused only on mechanical ventilation and its effects on recovery, now less invasive ventilation strategies paired with antibiotics raise the need for new standards of care.

“In our study, everyone received antibiotics, regardless of codetection or ventilation duration,” Dr. Karsies remarks. “The overarching conclusion is that when patients are that sick, antibiotics can’t hurt. But is that really true? One of our next steps should be to study which patients are the right candidates for antibiotics.”

 

Reference:

Karsies T, Shein SL, Diaz F, et al. Prevalence of Bacterial Codetection and Outcomes for Infants Intubated for Respiratory Infections. Pediatric Critical Care Medicine. Published online March 26, 2024. doi:10.1097/PCC.0000000000003500

Image credit: GettyImages

About the author

Pam Georgiana is a brand marketing professional and writer located in Bexley, Ohio. She believes that words bind us together as humans and that the best stories remind us of our humanity. She specialized in telling engaging stories for healthcare, B2B services, and nonprofits using classic storytelling techniques. Pam has earned an MBA in Marketing from Capital University in Columbus, Ohio.