Unnecessary antibiotic treatment of children hospitalized with RSV-bronchiolitis: risk factors and prescription patterns

Abstract

Background: Respiratory syncytial virus (RSV) is a main cause of respiratory tract infections, especially affecting young children. Antibiotics are often unnecessarily prescribed for the treatment of RSV. Such treatments can have effects on antibiotic resistance in future bacterial infections of treated patients and the general population. Objectives: We sought to understand the risk factors for and patterns of unnecessary antibiotic prescription in children with RSV. Methods: In a single center retrospective study in Israel, we obtained data of children aged <2 years (n=1015) hospitalized for RSV-bronchiolitis during 2008-2018, and ascertained not to have bacterial coinfections. Antibiotic misuse was defined as prescription of antibiotics during hospitalization of the study population. Patient and clinical variables were assessed as predictors of unnecessary antibiotic treatment in a multivariable logistic regression model. Results: Unnecessary antibiotic treatment rate of children infected with RSV and ascertained not to have a bacterial coinfection was estimated at 33.4% (95% CI 30.5%-36.4%). Increased likelihood of antibiotic misuse was associated with drawing bacterial cultures, and with variables indicative of a severe patient status: lower oxygen saturation, higher body temperature, tachypnea and prior recent emergency room visit. Older age and female sex were also associated with increased likelihood of unnecessary antibiotic treatment. Conclusions: Unnecessary antibiotic treatment in RSV patients was highly common and may be largely attributed to the physicians' perception of patients' severity. Improving prescription guidelines, implementing antibiotic stewardship programs and utilizing decision support systems may help achieve a better balance between prescribing and withholding antibiotic treatment.