ORIGINAL ARTICLE   

Minerva Pediatrics 2024 Dec 09

DOI: 10.23736/S2724-5276.24.07574-8

Copyright © 2024 EDIZIONI MINERVA MEDICA

lingua: Inglese

Antibiotic over-administration in hospitalized infants with Adenovirus infection

Rula AZZAM ¹, Oded SCHEUERMAN ^{1, 2}, Tal EIDLITZ-MARKUS ^{1, 3}, Lotem GOLDBERG ^{1, 2}, Shelly KAGAN ^{1, 2}, Tarek ZUABI ^{1, 2}, Gil AMARILYO ^{1, 4}, Vered SHKALIM ZEMER ^{1, 5}, Loulou SALEH ⁶, Yoel LEVINSKY ^{1, 2, 4} ✉

¹ Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; ² Department of Pediatrics B, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; ³ Pediatric Headache Clinic, Day Hospitalization Department, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; ⁴ Pediatric Rheumatology Unit, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; ⁵ Dan-Petah Tikva District, Clalit Health Services, Tel Aviv, Israel; ⁶ Microbiology Laboratory, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel

BACKGROUND: Infection with Adenovirus in children may clinically resemble a bacterial infection in several aspects, including high and prolonged fever, and increased inflammation markers. We aimed to estimate the rate of antibiotics administration among hospitalized infants with Adenovirus infection and to evaluate its justification.
METHODS: Included were hospitalized patients aged 2 months - 2 years who found positive for Adenovirus in PCR tests (Ct <36). Basic epidemiological and clinical features were retrieved retrospectively. A panel of three certified pediatricians examined each case to decide whether the antibiotic treatment was justified. Subsequently, the cases were divided into two groups - the group treated with antibiotics and the untreated group. The groups were compared in terms of the various parameters.
RESULTS: Out of 183 children with Adenovirus, 92 (50.3%) were treated with antibiotics. Only 42.4% of the antibiotics prescribed were medically justified. Children treated with antibiotics had a higher level of fever (39.4±0.90 vs. 38.6±0.98 °C; P<0.001), their blood oxygen saturation was higher (96.7±4.4% vs. 92.9±7.7%; P=0.0003), they were less dyspneic, and their inflammatory markers were higher as compared to those who had not been treated with antibiotics.
CONCLUSIONS: Approximately half of hospitalized pediatric patients <2 years old who were found positive for Adenovirus infection were treated with antibiotics during hospitalization. Most of these treatments were found retrospectively to be unjustified. Rapid and routine Adenovirus PCR testing can potentially reduce the rate of antibiotic treatment amongst hospitalized children.

KEY WORDS: Infection control; Pediatrics; Virus diseases; Adenoviridae; Anti-bacterial agents