Antibiotic use for children in the PICU with severe viral bronchiolitis Anjali Subbaswamy, MD; Chelsea Sanchez, MD; Claire Zeorlin, MD; Elizabeth Yakes Jimenez, PhD, RDN, LD
BACKGROUND: Viral bronchiolitis is not treated with antibiotics, but with supportive care. Antibiotics may be used for secondary bacterial pneumonia, which is difficult to diagnose in small children. Children with severe bronchiolitis are admitted to the PICU, and often receive empiric antibiotics.
OBJECTIVES: To examine clinical factors associated with systemic antibiotic use in severe bronchiolitis based on retrospective chart review of PICU patients.
METHODS: We identified children discharged from the UNMH PICU from January 2017-January 2019 diagnosed with severe viral bronchiolitis. Variables extracted included demographics, treatments, lab values and outcomes. Stata/SE 15.1 was used to calculate descriptive statistics and to examine relationships between clinical factors and antibiotic administration using a t-test, Pearson’s chi-square test or Fisher’s exact test.
RESULTS: Children (n=208) were on average 11.3 ± 8.6 (SD) months old with a length of stay of 10.8 ± 6.4 days. Seventy children (34%) received antibiotics. Fifteen children (7%) had a definitive diagnosis of bacterial pneumonia (positive tracheal culture). Children who received antibiotics were slightly younger than those who did not (average age 10.3 vs. 11.9 months; p = 0.09). Fifty-four percent of children on a ventilator (n=26) received antibiotics versus 31% of children who were not ventilated (p=0.02). Forty-one percent of children with elevated temperature (≥38°C; n=115) received antibiotics versus 24% of children with normal temperature (n=89; p=0.009). Seventy-two percent of children with high CRP (>2 mg/L; n=18) received antibiotics versus 56% of children with normal CRP (n=18; p=0.24).
CONCLUSIONS: In the UNMH PICU, a substantial proportion of children with severe viral bronchiolitis receive antibiotics without a definitive diagnosis of bacterial pneumonia. These children were younger and sicker, with fever, elevated CRP and mechanical ventilation. An evidence-based, expert opinion supported, clinical decision-making algorithm is needed to better identify children that require systemic antibiotics in the setting of severe viral bronchiolitis.
Subbaswamy, Anjali and Elizabeth Yakes Jimenez. "Antibiotic Use for Children in the PICU with severe viral bronchiolitis." (2021). https://digitalrepository.unm.edu/hsc_qips/60
Presented at the University of New Mexico GME/CPL 2021 Annual Quality Improvement and Patient Safety Symposium.