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• Bacterial pneumonia in RSV infections
  I-C. Sam
  Published on: 4 February 2005
• RSV co-infection in PICU
  Anton-Paul T Mayer
  Published on: 3 December 2004

• Published on: 4 February 2005

  Bacterial pneumonia in RSV infections

  • I-C. Sam, Associate Professor
  • Other Contributors:
    • R. J. Raja Lope

  Dear Editor,

  Duttweiler et al recently reported that 25/57 (43.9%) of intubated infants admitted with RSV bronchiolitis had concomitant bacterial pneumonia.[1] Diagnosis was made on a microbiological basis of significant bacterial growth and leucocytes seen in routinely obtained tracheal aspirates, with no other factors (clinical or radiological) taken into account.

  We agree that diagnosing bact...

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  Dear Editor,

  Duttweiler et al recently reported that 25/57 (43.9%) of intubated infants admitted with RSV bronchiolitis had concomitant bacterial pneumonia.[1] Diagnosis was made on a microbiological basis of significant bacterial growth and leucocytes seen in routinely obtained tracheal aspirates, with no other factors (clinical or radiological) taken into account.

  We agree that diagnosing bacterial pneumonia in patients with RSV is difficult, but using microbiological findings alone is insufficient. The upper respiratory tract is colonised soon after birth by “normal” flora that includes potential pathogens such as Moraxella catarrhalis (in 55% of infants aged 6 months), Streptococcus pneumoniae (38%), and Haemophilus influenzae (19%).[2] Culture of these organisms in tracheal aspirates may therefore represent colonisation. The presence of leucocytes may be due to the RSV infection or intubation itself, rather than indicating a bacterial infection. Positive endotracheal cultures have been found in equal frequency among infants with suspected pneumonia and in “well” controls.[3] Randolph et al reported probable or possible bacterial pneumonia in 38% of 63 intubated infants with RSV using microbiological criteria only, but felt that overdiagnosis was common in the absence of clear diagnostic criteria.[4]

  An important aspect of clinical microbiology is interpretation of culture results from non-sterile sites in the context of the appropriate clinical, radiological and laboratory data. This minimises overdiagnosis and overtreatment of infection. We agree that within this subset of ill RSV patients requiring ventilation, some are likely to have bacterial pneumonia co-infection. However, the quoted figure of 43.9% may be an overestimate, which may help explain why “the presence of concomitant bacterial pneumonia did not aggravate the clinical course”.[1] It would have been interesting to include tracheal cultures from non-infected controls.

  References

  (1). Duttweiler L, Nadal D, Frey B. Pulmonary and systemic bacterial co- infections in severe RSV bronchiolitis. Arch Dis Child 2004;89:1155-1157.

  (2). Faden H, Duffy L, Wasielewski R, et al. Relationship between nasopharyngeal colonization and the development of otitis media in children. J Infect Dis 1997;175:1440-1445.

  (3). Thureen PJ, Moreland S, Rodden DJ, et al. Failure of tracheal aspirate cultures to define the cause of respiratory deteriorations in neonates. Pediatr Infect Dis J 1993;12:560-564.

  (4). Randolph AG, Reder L, Englund JA. Risk of bacterial infection in previously healthy respiratory syncytial virus-infected young children admitted to the intensive care unit. Pediatr Infect Dis J 2004;23:990-994.

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  Conflict of Interest:
  None declared.

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• Published on: 3 December 2004

  RSV co-infection in PICU

  • Anton-Paul T Mayer, Consultant Paediatric Intensivist
  • Other Contributors:
    • Patricia A Fenton

  Dear Editor,

  The short report by Duttweiler et al [1] confirms our observation that the sub-population of RSV infected infants and children requiring intensive care needs to be treated differently, in terms of antibiotic treatment, from those who need routine hospital care. Bacterial sepsis is rare in RSV ward admissions as assessed by blood culture and CSF culture positive results [2] but secondary bacter...

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  Dear Editor,

  The short report by Duttweiler et al [1] confirms our observation that the sub-population of RSV infected infants and children requiring intensive care needs to be treated differently, in terms of antibiotic treatment, from those who need routine hospital care. Bacterial sepsis is rare in RSV ward admissions as assessed by blood culture and CSF culture positive results [2] but secondary bacterial respiratory infections may be a factor that tips the balance for needing additional supportive care.

  A Microbiologist and an Intensivist jointly assess all admissions to our PICU. During November 2002 to January 2003 we admitted 22 patients with RSV of whom 11 had significant secondary bacterial infections (Staphylococcus aureus n = 5, Haemophilus species n = 5 – two mixed with Moraxella species and Streptococcus pneumoniae n =1). We have developed a policy of pre-emptive antibiotic treatment with cefuroxime for all RSV admissions. This is changed to a narrower spectrum agent in the light of bacterial culture results, or stopped at 48 hours if clinically indicated and cultures are negative. We feel that early intervention is justified in this selected group.

  References

  (1). Duttweiler L, Nadal D, Frey B. Pulmonary and systemic bacterial co- infections in severe RSV bronchiolitis. Arch Dis Child 2004; 89:1155-1157.

  (2). Purcell K, Fergie J. Concurrent serious bacterial infections in 912 infants and children hospitalized for treatment of respiratory syncytial virus lower respiratory tract infection. Pediatr Infect Dis J 2004; 23(3):267-269.

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  Conflict of Interest:
  None declared.

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