Epidemiology and Outcomes of Bacterial Coinfection in Hospitalized Children With Respiratory Viral Infections: A Single Center Retrospective Chart Review.

OBJECTIVE: Children with viral respiratory illness are often suspected of having bacterial coinfection. This study was designed to determine the impact of bacterial coinfection on hospital course and outcomes and the rate of antimicrobial misuse. METHODS: Single-center retrospective chart review, including all hospitalized children who had a respiratory viral panel sent within 48 hours of admission from January 2015 to December 2019. Patients who had a positive respiratory, urine, blood culture within 24 hours of admission were identified. Demographics, resource utilization, and outcomes were compared between the 2 groups. RESULTS: This study included 2192 patients. Of those, 269 patients had positive bacterial cultures. Out of these cultures from 192 patients were identified as contaminants. True bacterial coinfection was 3.5% (77/2192). Almost 1/3 of admitted patients were prescribed empiric antimicrobials. Children with bacterial coinfection tended to be younger (median age 8.4 months vs 16.3 months, p < 0.01) and had higher proportion of prematurity (23.3% vs 12.1%, p < 0.01). Children with bacterial coinfection were more likely to require ICU admission (37.6% vs 23.9%, p < 0.01) and intubation (28.5% vs 5.3 %, p < 0.01). They had higher ICU (5.7 days vs 1.9 days, p < 0.01) and hospital length of stay (4.0 days vs 2.0 days, p < 0.01), higher mortality (2.6% vs 0.2%, p = 0.02), and a higher median cost of hospital care ($3774.44 vs $2424.49.90, p < 0.01). CONCLUSIONS: The rate of bacterial coinfection in hospitalized children with viral infections is very low, which contradicts the routine administration of empiric antimicrobials. Patients with coinfection require more hospital resources and have worse clinical outcomes.

Peripheral intravenous catheters in hospitalized patients: Practice, Dwell times, and factors impacting the dwell times: A single center retrospective study.

BACKGROUND: Despite being the most common hospital procedure, limited information is available on the peripheral intravenous (PIV) catheter insertion practices. This study was designed to evaluate the contemporary PIV insertion practice (all age groups), and to identify the patient and device-related factors influencing the dwell times (<18 years). METHODS: Single Center Retrospective study. Patients of all age groups admitted to the hospital for >4 midnights, from 01/2015 to 12/2019. Data extracted by automated EMR audits. Variables included patient demographics, number of PIVs inserted, PIV size, location, dwell time, and length of stay. Standard comparative analysis, including multivariable linear regression for dwell time performed for patients <18 years. RESULTS: A total of 44,198 (39,341 (89%) adults and 4857 (11%) children) PIVs on unique patients met study criteria, with mean duration of 2.8 ± 2.4 days in children and 2.6 ± 1.3 days in adults (p < 0.001). Pediatric PIV had more dwell time variation, with a higher proportion lasting <1-day and also >2 SD of the age-specific mean, compared to adults. Adults had significantly higher number of PIVs placed/week compared to children. The failure rate for PIV was 56% in children and 76% in adults (p < 0.001). 1 out of 5 adults required >5 PIV/admission. Forty-five percent of children requiring only one PIV versus 21.8% of seniors. Discharge department, body part, and PIV size were independently associated with the dwell duration in children. No PIV size, however, had an independent increase in dwell duration over the reference of the 24 Ga cannula in children. PIVs placed in ante cubital vein and upper arm had dwell duration 26% and 20% longer than PIVs placed in the hand. CONCLUSIONS: The failure rate of PIV is high, and patients are subjected to multiple insertions during hospitalization. Hospital unit, body part, and PIV size are associated with the dwell duration in children.

Comparative epidemiology, hospital course, and outcomes of viral respiratory infections in hospitalized pediatric patients.

PURPOSE: Acute respiratory illness is the leading cause of hospitalization for young children. Current guidelines recommend against testing to identify specific viruses due to a lack of data on the benefit of such testing. This study was designed to characterize epidemiology, hospital course, and outcomes of the various common virus -related hospitalization in children. METHOD: Single-center retrospective chart review. All patients who had respiratory viral panel sent within 48 h of admission. Comparative demographic and outcome analysis. Statistical analysis using ANOVA and multivariable regression. RESULT: 1831 patients met the study criteria. Rhinovirus was the most common virus (55.9%). Coronavirus had the highest proportion of infants (61.2%), while influenza had the least (17.8%). Positive urine culture identified in 8.1% of patients, with blood and urine positivity at 2% each. Rhinovirus and parainfluenza were spread throughout the year, while Corona, RSV, and influenza were more predominant in winter months. Overall PICU admission rate 22.8% and was highest for RSV (28.0%) and lowest for adenovirus (13.5%). No difference in ICU length of stay among different virus. Intubation rate was 5.6% with a median duration of 5 days. Median hospital length of stay was 2 days and differ significantly with different virus (maximum four RSV and metapneumo virus). Mortality in the study population was 0.3%. CONCLUSION: The difference in the disease course of different viruses may justify the resources required to test for the respiratory viral panel. This study data can serve as a benchmark for comparison of disease course of COVID-19 compared to other viral infections.