2623. Bacterial Co-detection and Outcomes for Infants with Bronchiolitis Requiring Emergency Department Intubation for Respiratory Failure

BACKGROUND: Viral bronchiolitis is a common cause of respiratory failure requiring intubation and ICU admission for infants. Bacterial codetection from respiratory cultures is common but its association with outcomes is unclear. METHODS: We conducted a retrospective cohort study over 5 years of infants <1 year with suspected bronchiolitis who were intubated in our ED with subsequent ICU admission. We evaluated the association between bacterial codetection (bacteria + many PMNs) and outcomes (mechanical ventilation (MV) duration, ICU LOS). Analysis was performed using gamma regression. Results are reported as risk ratios (RR) or adjusted risk ratios (aRR). RESULTS: 149 patients were analyzed (median age 1.3 months, 59% male, 54% prematurity). 91% had confirmed viral infection (56% RSV, 35% non-RSV, 13% polyviral); 52% had codetection. Median MV duration was 5.1 days; median ICU LOS was 6.8 days. Prematurity, PRISM3 score, RSV, black race, and positive non-respiratory culture were associated with longer MV duration. Prematurity, RSV positivity and positive non-respiratory culture were associated with longer ICU LOS. Bacterial codetection (RR 0.82; 0.68–1.0) was associated with shorter MV duration and shorter ICU LOS (RR 0.80; 0.67–0.94); this remained true after adjusting for confounders (aRR for shorter MV duration: 0.82; 0.69–0.98; aRR for shorter ICU LOS: 0.81; 0.69–0.94). 95% of patients with positive cultures (109/115) had appropriate ED antibiotics; median time to correct antibiotics was 1.4 hours. Further investigation showed that bacterial codetection was associated with decreased MV duration in those with time to correct antibiotics of ≤1.4 hours (aRR 0.70; 0.54–0.89) but not in those whose time to antibiotics was >1.4 hours (aRR 0.98; 0.78–1.24). CONCLUSION: In infants intubated in the ED for bronchiolitis, bacterial codetection was associated with shorter ICU LOS overall and with shorter MV duration among patients with rapid time to correct antibiotics; however, there was no significant association between bacterial codetection and MV duration among patients with longer time to correct antibiotics. Further research is needed to elucidate the true impact of bacterial codetection as well as empiric antibiotic administration on outcomes in infants intubated for bronchiolitis. DISCLOSURES: All authors: No reported disclosures.