921 Bacteraemia and Antibiotic Use in Severe Respiratory Syncytial Virus Infections

Aims: To determine the frequency of and the risk factors for bacteraemia in infants hospitalized in the pediatric intensive care unit (PICU) with respiratory syncytial virus (RSV) infection and to precise the current use of antibiotics in these patients. Methods: Retrospective study of infants, aged 0-24 months, admitted to a pediatric intensive care unit with proven RSV infection over a nine year period (2000-2008). Infants with concurrent bacteraemia and RSV infection were identified, and risk factors for bacteraemia were identified in univariate then in multivariate analysis (logistic regression model). The use of antibiotics in these infants was also precised. Results: During the study period, a total of 169 infants were admitted to the PICU with proven RSV infection. Blood cultures were realized in all infants. Fourteen (8.3%) of the 169 RSV positive infants had bacteraemia. RSV positive infants had a significantly higher incidence of bacteraemia if they had a C-reactive protein level superior to 88 mg/l (27%), a positive bacteriology of tracheal aspirates at admission (32%) or if they required high frequency ventilation (28.5%). Ninety three (55%) of the RSV infected infants received antibiotics. Conclusions: Bacteraemia is rare in RSV infected infants admitted to the PICU. However, the incidence of antibiotic prescription in these infants is high. Children with severe RSV infection are more likely to be bacteraemic if they had a C-reactive protein level superior to 88 mg/l, a positive bacteriology of tracheal aspirates at admission or if they required high frequency ventilation.