G77(P) Respiratory tract infection in children with a neurodisability – microbiology, antibiotic consumption and hospital admission – a service evaluation for a high-risk group. (25th October 2020)

• Record Type: Journal Article
• Authors: Marrable, L; Sanner, JRF; Flanigan, M; Wolff, T; Hurley, MN
• Is Part Of: Archives of disease in childhood. Volume 105(2020)Supplement 1
• Page Start: A24
• Page End: A24
• Publication Date: 2020-10-25
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2020-rcpch.58
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aims: Children with neurodisability (ND) have an increased risk of respiratory tract infections (RTI). We aimed to establish the organisms implicated in pulmonary infection in children with ND in our area in the context of antibiotic provision, as well as document hospital admissions within this population. Methods: The City Rapid Access Physiotherapy Service (RAPS) cares for children with ND who have frequent RTIs. A random number generator was used to select a sample of 30 children from a complete list of 74 children accessing this service. Respiratory tract samples are taken when RTI is suspected. Patient records were used to investigate respiratory microbiology, hospital admissions and inpatient antibiotic provision, from 30/09/15 to 30/09/19 inclusive. Results: Of the 30 children, 15 were male; 14 had cerebral palsy, 6 had a neurodegenerative disease, 5 had a neuromuscular condition and 5 had other complex ND conditions. A total of 184 admissions were documented across 26 patients; the average admission length was 9.5 days (range 0–116 days). The average number of positive respiratory microbiology samples per patient was 8 (range 0–54). 7 patients had no positive respiratory samples. 185 (76.8%) positive isolates were viral and 56 (23.3%) were bacterial. Common isolates are presented in table 1 . 18 patients received prophylactic antibiotics, notably azithromycin (16). In total, 176 courses of inpatient antibiotics were prescribed; 36 were co-amoxiclav. The average number of inpatient antibiotics prescribed per child was 6 (range 0–41). Lower RTI was the most common (46.1%) documented reason for antibiotic prescription. Conclusion: Viruses are most commonly isolated from children with ND during an exacerbation of symptoms, although many bacteria are also implicated. Infections in these patients lead to frequent inpatient admissions and are managed by a wide variety of antibiotics, of which co-amoxiclav is the most commonly prescribed. It is uncertain whether there is an association between the microbiology and severity of disease.