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Co-infections in children hospitalised for bronchiolitis: role of roomsharing.

ABSTRACT: BACKGROUND:Bronchiolitis is a major cause for hospitalisation in young children during the winter season, with respiratory syncytial virus (RSV) as the main causative virus. Apart from standard hygiene measures, cohorting of RSV-infected patients separately from RSV-negative patients is frequently applied to prevent cross-infection, although evidence to support this practice is lacking. The objective is to evaluate the risk of room sharing between RSV-positive and RSV-negative patients. METHODS:We performed a prospective observational cohort study in children < 2 years hospitalised with acute bronchiolitis. During the first day of admission, patients shared one room, pending results of virological diagnosis (PCR). When diagnostic results were available, RSV-positive and RSV-negative patients were separated. Standard hygienic measures (gowns, gloves, masks, hand washing) were used in all patients. RESULTS:We included 48 patients (83% RSV-positive). Co-infection was found in nine patients at admission, and two during hospitalisation (23%). The two patients with acquired co-infection had been nursed in a single room during the entire admission. None of 37 patients sharing a room with other bronchiolitis patients (20 with patients with a different virus) were co-infected during admission. Disease severity in co-infection was not worse than in mono-infection. CONCLUSION:One in five patients with bronchiolitis was co-infected, but co-infection acquired during admission was rare and was not associated with more severe disease. Room sharing between RSV-positive and RSV-negative patients (on the first day of admission) did not influence the risk of co-infection, suggesting that cohorting of RSV-infected patients separate from non-RSV-infected patients may not be indicated.

SUBMITTER: Bekhof J

PROVIDER: S-EPMC3808260 | biostudies-literature | 2013 Dec

REPOSITORIES: biostudies-literature

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Co-infections in children hospitalised for bronchiolitis: role of roomsharing.

Bekhof Jolita J Bakker Joline J Reimink Roelien R Wessels Mirjam M Langenhorst Veerle V Brand Paul L P PL Ruijs Gijs J H M GJ

Journal of clinical medicine research 20131012 6

<h4>Background</h4>Bronchiolitis is a major cause for hospitalisation in young children during the winter season, with respiratory syncytial virus (RSV) as the main causative virus. Apart from standard hygiene measures, cohorting of RSV-infected patients separately from RSV-negative patients is frequently applied to prevent cross-infection, although evidence to support this practice is lacking. The objective is to evaluate the risk of room sharing between RSV-positive and RSV-negative patients.< ...[more]

PMID: 24171054

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Project description:ObjectiveBronchiolitis, one of the most common reasons for hospitalisation in young children, is particularly problematic in Indigenous children. Macrolides may be beneficial in settings where children have high rates of nasopharyngeal bacterial carriage and frequent prolonged illness. The aim of our double-blind placebo-controlled randomised trial was to determine if a large single dose of azithromycin (compared to placebo) reduced length of stay (LOS), duration of oxygen (O2) and respiratory readmissions within 6 months of children hospitalised with bronchiolitis. We also determined the effect of azithromycin on nasopharyngeal microbiology.MethodsChildren aged ?18 months were randomised to receive a single large dose (30 mg/kg) of either azithromycin or placebo within 24 hrs of hospitalisation. Nasopharyngeal swabs were collected at baseline and 48 hrs later. Primary endpoints (LOS, O2) were monitored every 12 hrs. Hospitalised respiratory readmissions 6-months post discharge was collected.Results97 children were randomised (n?=?50 azithromycin, n?=?47 placebo). Median LOS was similar in both groups; azithromycin?=?54 hours, placebo?=?58 hours (difference between groups of 4 hours 95%CI -8, 13, p?=?0.6). O2 requirement was not significantly different between groups; Azithromycin?=?35 hrs; placebo?=?42 hrs (difference 7 hours, 95%CI -9, 13, p?=?0.7). Number of children re-hospitalised was similar 10 per group (OR?=?0.9, 95%CI 0.3, 2, p?=?0.8). At least one virus was detected in 74% of children. The azithromycin group had reduced nasopharyngeal bacterial carriage (p?=?0.01) but no difference in viral detection at 48 hours.ConclusionAlthough a single dose of azithromycin reduces carriage of bacteria, it is unlikely to be beneficial in reducing LOS, duration of O2 requirement or readmissions in children hospitalised with bronchiolitis. It remains uncertain if an earlier and/or longer duration of azithromycin improves clinical and microbiological outcomes for children. The trial was registered with the Australian and New Zealand Clinical Trials Register. Clinical trials number: ACTRN12608000150347. http://www.anzctr.org.au/TrialSearch.aspx.

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Co-infections in children hospitalised for bronchiolitis: role of roomsharing.

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Co-infections in children hospitalised for bronchiolitis: role of roomsharing.

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