• Todd Karsies, Steven L Shein, Franco Diaz, Pablo Vasquez-Hoyos, Robin Alexander, Steven Pon, Sebastián González-Dambrauskas, and with the Bronchiolitis And COdetectioN (BACON) Study Investigators; for the Bronchiolitis Subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators Network and the Red Colaborativa Pediátrica de Latinoamérica Network.
• Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH.
• Pediatr Crit Care Me. 2024 Mar 26.

ObjectivesTo determine the prevalence of respiratory bacterial codetection in children younger than 2 years intubated for acute lower respiratory tract infection (LRTI), primarily viral bronchiolitis, and identify the association of codetection with mechanical ventilation duration.DesignProspective observational study evaluating the prevalence of bacterial codetection (moderate/heavy growth of pathogenic bacterial plus moderate/many polymorphonuclear neutrophils) and the impact of codetection on invasive mechanical ventilation (IMV) duration.SettingPICUs in 12 high and low/middle-income countries.PatientsChildren younger than 2 years old requiring intubation and ICU admission for LRTI and who had a lower respiratory tract culture obtained at the time of intubation between December 1, 2019, and November 30, 2020.InterventionsNone.Measurements And Main ResultsOf the 472 analyzed patients (median age 4.5 mo), 55% had a positive respiratory culture and 29% (n = 138) had codetection. 90% received early antibiotics starting at a median of 0.36 hours after respiratory culture. Median (interquartile range) IMV duration was 151 hours (88, 226), and there were 28 deaths (5.3%). Codetection was more common with younger age, a positive respiratory syncytial virus test, and an admission diagnosis of bronchiolitis; it was less common with an admission diagnosis of pneumonia, with admission to a low-/middle-income site, and in those receiving vasopressors. When adjusted for confounders, codetection was not associated with longer IMV duration (adjusted relative risk 0.854 [95% CI 0.684-1.065]). We could not exclude the possibility that codetection might be associated with a 30-hour shorter IMV duration compared with no codetection, although the CI includes the null value.ConclusionsBacterial codetection was present in almost a third of children younger than 2 years requiring intubation and ICU admission for LRTI, but this was not associated with prolonged IMV. Further large studies are needed to evaluate if codetection is associated with shorter IMV duration.Copyright © 2024 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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