Antibiotic utilization in hospitalized children under 2 years of age with influenza or respiratory syncytial virus infection - a comparative, retrospective analysis
Background: Infections due to Respiratory Syncytial Virus (RSV) and Influenza virus (FLU) are leading causes of
hospitalization in young children. Yet, there is little data on factors associated with antibiotic use in these patients.
Methods: We conducted a retrospective, single-center study of all patients below 2 years of age hospitalized
between 2014 and 2018. We compared children with RSV infection to children with FLU infection analyzing clinical
characteristics and factors contributing to an increased rate of antimicrobial utilization.
Results: RSV infection was diagnosed in 476/573 (83.1%), FLU in 95/573 (16.6%), and RSV-FLU-co-infection in 2/573
(0.3%) patients. Median age was lower for RSV compared to FLU (4 vs. 12 months; p < 0.0001). Children with RSV
had longer hospitalization (5 vs. 4 days; p = 0.0023) and needed oxygen more frequently (314/476 vs. 23/95; p <
0.0001) than FLU patients. There was no significant difference in the overall antibiotic utilization between RSV and
FLU patients (136/476 vs. 21/95; p = 0.2107). Logistic regression analyses revealed that septic appearance on
admission (odds ratio [OR] 8.95, 95% confidence interval [CI] 1.5–54.1), acute otitis media (OR 4.5, 95% CI 2.1–9.4), a
longer oxygen therapy (OR 1.40; 95% CI 1.13–1.74) and a higher C-reactive protein (CRP) (OR 1.7, 95% CI 1.5–2.0)
were significantly associated with antibiotic use in both groups, but not age or pneumonia.
Conclusions: In our cohort, the rate of antibiotic utilization was comparable between RSV and FLU patients, while
for both groups distinct clinical presentation and a high CRP value were associated with higher antibiotic use