Infections and Asthma in the Pediatric Intensive Care Unit: Prevalence and Contribution to Disease Severity

This study was performed to ascertain the prevalence of respiratory infections in pediatric intensive care unit (PICU) asthmatics and whether infections increase morbidity. A retrospective cohort study on patients admitted to PICU for status asthmaticus over a 3 year period. Hospital course, radiographic findings, and microbiology data were reviewed. Statistical analyses were performed and covariates with P <= 0.05 were considered significant. Four hundred forty-eight patients were admitted during the study period. One hundred fifty-nine infectious pathogens were identified in 146 patients. Thirty-seven percent of patients tested for viruses were positive and 11% tested for mycoplasma pneumonia had positive IgM serology. PICU length of stay (LOS) and overall LOS for patients with infection were greater than those without (P = 0.05). Thirty-one patients required mechanical ventilation and 9 had bacterial or viral infections. There was no difference in the rate of intubation or length of ventilation for those with infection compared to those without. Eighty-three patients were discharged with diagnosis of pneumonia, but 254 received antibiotics in the PICU. Patients with fever (OR 1.9, CI 1.1, 3.0), intubated (OR 17.1, CI 4.5, 65), or a CXR read as pneumonia (OR 16, CI 6.1, 41.7) were more likely to receive antibiotics in the PICU (P < 0.05). Viral infections are common in PICU patients with status asthmaticus. Patients with infections have a greater LOS than those not infected, but do not have increased rate of intubation or length of ventilation. Patients receive antibiotics based on clinical and radiographic findings, but laboratory testing rarely confirms the presence of bacterial or atypical infections.