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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...

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Autores principales: 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
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
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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.
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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
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