Cargando…
Community-Onset Bacterial Coinfection in Children Critically Ill With Severe Acute Respiratory Syndrome Coronavirus 2 Infection
BACKGROUND: Community-onset bacterial coinfection in adults hospitalized with coronavirus disease 2019 (COVID-19) is reportedly uncommon, though empiric antibiotic use has been high. However, data regarding empiric antibiotic use and bacterial coinfection in children with critical illness from COVID...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10034750/ https://www.ncbi.nlm.nih.gov/pubmed/36968962 http://dx.doi.org/10.1093/ofid/ofad122 |
_version_ | 1784911274935582720 |
---|---|
author | Moffitt, Kristin L Nakamura, Mari M Young, Cameron C Newhams, Margaret M Halasa, Natasha B Reed, J Nelson Fitzgerald, Julie C Spinella, Philip C Soma, Vijaya L Walker, Tracie C Loftis, Laura L Maddux, Aline B Kong, Michele Rowan, Courtney M Hobbs, Charlotte V Schuster, Jennifer E Riggs, Becky J McLaughlin, Gwenn E Michelson, Kelly N Hall, Mark W Babbitt, Christopher J Cvijanovich, Natalie Z Zinter, Matt S Maamari, Mia Schwarz, Adam J Singh, Aalok R Flori, Heidi R Gertz, Shira J Staat, Mary A Giuliano, John S Hymes, Saul R Clouser, Katharine N McGuire, John Carroll, Christopher L Thomas, Neal J Levy, Emily R Randolph, Adrienne G |
author_facet | Moffitt, Kristin L Nakamura, Mari M Young, Cameron C Newhams, Margaret M Halasa, Natasha B Reed, J Nelson Fitzgerald, Julie C Spinella, Philip C Soma, Vijaya L Walker, Tracie C Loftis, Laura L Maddux, Aline B Kong, Michele Rowan, Courtney M Hobbs, Charlotte V Schuster, Jennifer E Riggs, Becky J McLaughlin, Gwenn E Michelson, Kelly N Hall, Mark W Babbitt, Christopher J Cvijanovich, Natalie Z Zinter, Matt S Maamari, Mia Schwarz, Adam J Singh, Aalok R Flori, Heidi R Gertz, Shira J Staat, Mary A Giuliano, John S Hymes, Saul R Clouser, Katharine N McGuire, John Carroll, Christopher L Thomas, Neal J Levy, Emily R Randolph, Adrienne G |
author_sort | Moffitt, Kristin L |
collection | PubMed |
description | BACKGROUND: Community-onset bacterial coinfection in adults hospitalized with coronavirus disease 2019 (COVID-19) is reportedly uncommon, though empiric antibiotic use has been high. However, data regarding empiric antibiotic use and bacterial coinfection in children with critical illness from COVID-19 are scarce. METHODS: We evaluated children and adolescents aged <19 years admitted to a pediatric intensive care or high-acuity unit for COVID-19 between March and December 2020. Based on qualifying microbiology results from the first 3 days of admission, we adjudicated whether patients had community-onset bacterial coinfection. We compared demographic and clinical characteristics of those who did and did not (1) receive antibiotics and (2) have bacterial coinfection early in admission. Using Poisson regression models, we assessed factors associated with these outcomes. RESULTS: Of the 532 patients, 63.3% received empiric antibiotics, but only 7.1% had bacterial coinfection, and only 3.0% had respiratory bacterial coinfection. In multivariable analyses, empiric antibiotics were more likely to be prescribed for immunocompromised patients (adjusted relative risk [aRR], 1.34 [95% confidence interval {CI}, 1.01–1.79]), those requiring any respiratory support except mechanical ventilation (aRR, 1.41 [95% CI, 1.05–1.90]), or those requiring invasive mechanical ventilation (aRR, 1.83 [95% CI, 1.36–2.47]) (compared with no respiratory support). The presence of a pulmonary comorbidity other than asthma (aRR, 2.31 [95% CI, 1.15–4.62]) was associated with bacterial coinfection. CONCLUSIONS: Community-onset bacterial coinfection in children with critical COVID-19 is infrequent, but empiric antibiotics are commonly prescribed. These findings inform antimicrobial use and support rapid de-escalation when evaluation shows coinfection is unlikely. |
format | Online Article Text |
id | pubmed-10034750 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-100347502023-03-24 Community-Onset Bacterial Coinfection in Children Critically Ill With Severe Acute Respiratory Syndrome Coronavirus 2 Infection Moffitt, Kristin L Nakamura, Mari M Young, Cameron C Newhams, Margaret M Halasa, Natasha B Reed, J Nelson Fitzgerald, Julie C Spinella, Philip C Soma, Vijaya L Walker, Tracie C Loftis, Laura L Maddux, Aline B Kong, Michele Rowan, Courtney M Hobbs, Charlotte V Schuster, Jennifer E Riggs, Becky J McLaughlin, Gwenn E Michelson, Kelly N Hall, Mark W Babbitt, Christopher J Cvijanovich, Natalie Z Zinter, Matt S Maamari, Mia Schwarz, Adam J Singh, Aalok R Flori, Heidi R Gertz, Shira J Staat, Mary A Giuliano, John S Hymes, Saul R Clouser, Katharine N McGuire, John Carroll, Christopher L Thomas, Neal J Levy, Emily R Randolph, Adrienne G Open Forum Infect Dis Major Article BACKGROUND: Community-onset bacterial coinfection in adults hospitalized with coronavirus disease 2019 (COVID-19) is reportedly uncommon, though empiric antibiotic use has been high. However, data regarding empiric antibiotic use and bacterial coinfection in children with critical illness from COVID-19 are scarce. METHODS: We evaluated children and adolescents aged <19 years admitted to a pediatric intensive care or high-acuity unit for COVID-19 between March and December 2020. Based on qualifying microbiology results from the first 3 days of admission, we adjudicated whether patients had community-onset bacterial coinfection. We compared demographic and clinical characteristics of those who did and did not (1) receive antibiotics and (2) have bacterial coinfection early in admission. Using Poisson regression models, we assessed factors associated with these outcomes. RESULTS: Of the 532 patients, 63.3% received empiric antibiotics, but only 7.1% had bacterial coinfection, and only 3.0% had respiratory bacterial coinfection. In multivariable analyses, empiric antibiotics were more likely to be prescribed for immunocompromised patients (adjusted relative risk [aRR], 1.34 [95% confidence interval {CI}, 1.01–1.79]), those requiring any respiratory support except mechanical ventilation (aRR, 1.41 [95% CI, 1.05–1.90]), or those requiring invasive mechanical ventilation (aRR, 1.83 [95% CI, 1.36–2.47]) (compared with no respiratory support). The presence of a pulmonary comorbidity other than asthma (aRR, 2.31 [95% CI, 1.15–4.62]) was associated with bacterial coinfection. CONCLUSIONS: Community-onset bacterial coinfection in children with critical COVID-19 is infrequent, but empiric antibiotics are commonly prescribed. These findings inform antimicrobial use and support rapid de-escalation when evaluation shows coinfection is unlikely. Oxford University Press 2023-03-06 /pmc/articles/PMC10034750/ /pubmed/36968962 http://dx.doi.org/10.1093/ofid/ofad122 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Major Article Moffitt, Kristin L Nakamura, Mari M Young, Cameron C Newhams, Margaret M Halasa, Natasha B Reed, J Nelson Fitzgerald, Julie C Spinella, Philip C Soma, Vijaya L Walker, Tracie C Loftis, Laura L Maddux, Aline B Kong, Michele Rowan, Courtney M Hobbs, Charlotte V Schuster, Jennifer E Riggs, Becky J McLaughlin, Gwenn E Michelson, Kelly N Hall, Mark W Babbitt, Christopher J Cvijanovich, Natalie Z Zinter, Matt S Maamari, Mia Schwarz, Adam J Singh, Aalok R Flori, Heidi R Gertz, Shira J Staat, Mary A Giuliano, John S Hymes, Saul R Clouser, Katharine N McGuire, John Carroll, Christopher L Thomas, Neal J Levy, Emily R Randolph, Adrienne G Community-Onset Bacterial Coinfection in Children Critically Ill With Severe Acute Respiratory Syndrome Coronavirus 2 Infection |
title | Community-Onset Bacterial Coinfection in Children Critically Ill With Severe Acute Respiratory Syndrome Coronavirus 2 Infection |
title_full | Community-Onset Bacterial Coinfection in Children Critically Ill With Severe Acute Respiratory Syndrome Coronavirus 2 Infection |
title_fullStr | Community-Onset Bacterial Coinfection in Children Critically Ill With Severe Acute Respiratory Syndrome Coronavirus 2 Infection |
title_full_unstemmed | Community-Onset Bacterial Coinfection in Children Critically Ill With Severe Acute Respiratory Syndrome Coronavirus 2 Infection |
title_short | Community-Onset Bacterial Coinfection in Children Critically Ill With Severe Acute Respiratory Syndrome Coronavirus 2 Infection |
title_sort | community-onset bacterial coinfection in children critically ill with severe acute respiratory syndrome coronavirus 2 infection |
topic | Major Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10034750/ https://www.ncbi.nlm.nih.gov/pubmed/36968962 http://dx.doi.org/10.1093/ofid/ofad122 |
work_keys_str_mv | AT moffittkristinl communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT nakamuramarim communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT youngcameronc communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT newhamsmargaretm communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT halasanatashab communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT reedjnelson communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT fitzgeraldjuliec communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT spinellaphilipc communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT somavijayal communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT walkertraciec communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT loftislaural communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT madduxalineb communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT kongmichele communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT rowancourtneym communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT hobbscharlottev communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT schusterjennifere communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT riggsbeckyj communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT mclaughlingwenne communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT michelsonkellyn communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT hallmarkw communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT babbittchristopherj communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT cvijanovichnataliez communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT zintermatts communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT maamarimia communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT schwarzadamj communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT singhaalokr communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT floriheidir communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT gertzshiraj communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT staatmarya communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT giulianojohns communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT hymessaulr communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT clouserkatharinen communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT mcguirejohn communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT carrollchristopherl communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT thomasnealj communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT levyemilyr communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection AT randolphadrienneg communityonsetbacterialcoinfectioninchildrencriticallyillwithsevereacuterespiratorysyndromecoronavirus2infection |