Bacterial coinfections in infants with bronchiolotis

ABSTRACT

Although bronchiolitis is a viral infection of the lower respiratory tract in children, yet, antibiotics are widely prescribed in the treatment of those patients. This study investigated the frequency of bacterial co-infection in infants with bronchiolitis, in relation to the clinical signs, X-Ray findings and total and differential leukocytic count. The overall aim was to try to find out simple clinical and/or investigation criteria to rationalize antibiotic therapy in such patients. Sixty-nine patients with clinical diagnosis of bronchiolitis [34 boys and 35 girls] with age range of 1 - 15 months, mean 5.09 +/- 2.84 months were included in the study. Bacterial coinfection was diagnosed by culture of sputum obtained by tracheal aspirate done under direct laryngoscopic visualization, using sterile mucous extractor. Bacteria was isolated from 37.6% of the studied children, Staphylococci, pneumococci, beta hemolytic streptococci were the most common invaders. High and prolonged fever, toxic look, wide spread crepitations on chest auscultation, were more frequently encountered in patients with concomitant bacterial infection, and the difference was statistically significant. Radiological picture of wide spread infiltrates and/or consolidation was a characteristic feature of patients with positive bacterial culture 61.4%, compared to 4.6% in those with no bacterial isolates. Meanwhile, higher total leukocytic count was observed in patients with bacterial coinfection [mean 11.7 +/- 3.8] compared to those with negative culture [9.89 +/- 3.1]. Patients with bacterial coinfection required significantly longer duration of in-patients treatment [7.6 '2.9 days] compared to those without [4.7 +/- 1.9]. Among the above mentioned clinical and investigations criteria, X Ray findings showed high specificity [95.3%], positive and negative predictive values [88.8%, and 80.3%], but is less sensitive in diagnosis of bacterial coinfection [61.5%]. The presence of wide spread crepitations is more sensitive [79.9%], carries high negative predictivity [85%], but less specific [79%]. The presence of both together is highly specific [97.6%], but less sensitive and predictive. It was concluded that careful clinical assessment of patients with bronchiolitis can help to identify candidates for antibiotic therapy, particularly so, if radiological facilities are available