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García-García ML, Alcolea S, Alonso-López P, Martín-Martín C, Tena-García G, Casas I, Pozo F, Méndez-Echevarría A, Hurtado-Gallego J, Calvo C. Antibiotic Utilization in Hospitalized Children with Bronchiolitis: A Prospective Study Investigating Clinical and Epidemiological Characteristics at a Secondary Hospital in Madrid (2004-2022). Pathogens 2023; 12:1397. [PMID: 38133281 PMCID: PMC10747854 DOI: 10.3390/pathogens12121397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Bronchiolitis is a viral respiratory infection, with respiratory syncytial virus (RSV) being the most frequent agent, requiring hospitalization in 1% of affected children. However, there continues to be a noteworthy incidence of antibiotic prescription in this setting, further exacerbating the global issue of antibiotic resistance. This study, conducted at Severo Ochoa Hospital in Madrid, Spain, focused on antibiotic usage in children under 2 years of age who were hospitalized for bronchiolitis between 2004 and 2022. In that time, 5438 children were admitted with acute respiratory infection, and 1715 infants (31.5%) with acute bronchiolitis were included. In total, 1470 (87%) had a positive viral identification (66% RSV, 32% HRV). Initially, antibiotics were prescribed to 13.4% of infants, but this percentage decreased to 7% during the COVID-19 pandemic thanks to adherence to guidelines and the implementation of rapid and precise viral diagnostic methods in the hospital. HBoV- and HAdV-infected children and those with viral coinfections were more likely to receive antibiotics in the univariate analysis. A multivariate logistic regression analysis revealed a statistically independent association between antibiotic prescription and fever > 38 °C (p < 0.001), abnormal chest-X ray (p < 0.001), ICU admission (p = 0.015), and serum CRP (p < 0.001). In conclusion, following guidelines and the availability of rapid and reliable viral diagnostic methods dramatically reduces the unnecessary use of antibiotics in infants with severe bronchiolitis.
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Affiliation(s)
- María Luz García-García
- Pediatrics Department, Severo Ochoa University Hospital, 28911 Leganés, Spain; (M.L.G.-G.); (P.A.-L.); (C.M.-M.); (G.T.-G.)
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.-E.); (J.H.-G.)
- Puerta de Hierro Health Research Institute (IDIPHISA), 28222 Majadahonda, Spain
- Traslational Research Network in Pediatric Infectious Diseases (RITIP), 28046 Madrid, Spain
| | - Sonia Alcolea
- Pediatrics Department, Severo Ochoa University Hospital, 28911 Leganés, Spain; (M.L.G.-G.); (P.A.-L.); (C.M.-M.); (G.T.-G.)
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.-E.); (J.H.-G.)
- Puerta de Hierro Health Research Institute (IDIPHISA), 28222 Majadahonda, Spain
- La Paz University Hospital, 28046 Madrid, Spain
- La Paz Institute for Health Research (IdiPAZ), 28029 Madrid, Spain
- Universidad Autónoma Madrid (UAM), 28029 Madrid, Spain
| | - Patricia Alonso-López
- Pediatrics Department, Severo Ochoa University Hospital, 28911 Leganés, Spain; (M.L.G.-G.); (P.A.-L.); (C.M.-M.); (G.T.-G.)
- Puerta de Hierro Health Research Institute (IDIPHISA), 28222 Majadahonda, Spain
| | - Clara Martín-Martín
- Pediatrics Department, Severo Ochoa University Hospital, 28911 Leganés, Spain; (M.L.G.-G.); (P.A.-L.); (C.M.-M.); (G.T.-G.)
- Puerta de Hierro Health Research Institute (IDIPHISA), 28222 Majadahonda, Spain
| | - Guadalupe Tena-García
- Pediatrics Department, Severo Ochoa University Hospital, 28911 Leganés, Spain; (M.L.G.-G.); (P.A.-L.); (C.M.-M.); (G.T.-G.)
- Puerta de Hierro Health Research Institute (IDIPHISA), 28222 Majadahonda, Spain
| | - Inmaculada Casas
- Respiratory Virus and Influenza Unit, National Center of Microbiology, 28222 Madrid, Spain; (I.C.); (F.P.)
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Francisco Pozo
- Respiratory Virus and Influenza Unit, National Center of Microbiology, 28222 Madrid, Spain; (I.C.); (F.P.)
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ana Méndez-Echevarría
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.-E.); (J.H.-G.)
- Traslational Research Network in Pediatric Infectious Diseases (RITIP), 28046 Madrid, Spain
- La Paz University Hospital, 28046 Madrid, Spain
- La Paz Institute for Health Research (IdiPAZ), 28029 Madrid, Spain
- Universidad Autónoma Madrid (UAM), 28029 Madrid, Spain
| | - Jara Hurtado-Gallego
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.-E.); (J.H.-G.)
- La Paz University Hospital, 28046 Madrid, Spain
| | - Cristina Calvo
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.-E.); (J.H.-G.)
- Traslational Research Network in Pediatric Infectious Diseases (RITIP), 28046 Madrid, Spain
- La Paz University Hospital, 28046 Madrid, Spain
- La Paz Institute for Health Research (IdiPAZ), 28029 Madrid, Spain
- Universidad Autónoma Madrid (UAM), 28029 Madrid, Spain
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Gastaldi A, Donà D, Barbieri E, Giaquinto C, Bont LJ, Baraldi E. COVID-19 Lesson for Respiratory Syncytial Virus (RSV): Hygiene Works. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121144. [PMID: 34943339 PMCID: PMC8700687 DOI: 10.3390/children8121144] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/25/2021] [Accepted: 12/02/2021] [Indexed: 02/05/2023]
Abstract
Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infections (LRTIs) in infants worldwide. The global direct medical cost associated with RSV LRTIs reaches billions of dollars, with the highest burden in low–middle-income countries. Many efforts have been devoted to improving its prevention and management, including both non-pharmaceutical and pharmaceutical strategies, often with limited routine use in high-income countries due to high costs. During the ongoing COVID-19 pandemic, a dramatic decrease in RSV infections (up to 70–90%) has been reported around the globe, directly related to the implementation of containment measures (face masks, hand hygiene, and social distancing). Primary prevention has demonstrated the highest cost effectiveness ratio in reducing the burden of a respiratory infection such as RSV, never reached before. Thus, we emphasize the importance of non-pharmaceutical preventive hygiene measures that should be implemented and maintained even after the COVID-19 outbreak.
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Affiliation(s)
- Andrea Gastaldi
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padua, 35128 Padua, Italy; (A.G.); (E.B.); (C.G.)
- Department of Pediatrics, Woman and Child Hospital, University of Verona, 37126 Verona, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padua, 35128 Padua, Italy; (A.G.); (E.B.); (C.G.)
- Correspondence:
| | - Elisa Barbieri
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padua, 35128 Padua, Italy; (A.G.); (E.B.); (C.G.)
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padua, 35128 Padua, Italy; (A.G.); (E.B.); (C.G.)
| | - Louis J. Bont
- Department of Pediatrics, Wilhelmina Children’s Hospital, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
- Respiratory Syncytial Virus Network (ReSViNET) Foundation, 3703 CD Zeist, The Netherlands
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University of Padua, 35128 Padua, Italy;
- Fondazione Istituto di Ricerca Pediatrica, 35127 Padua, Italy
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