Bandemia in Children with Viral . Does it Effect Antibiotic Use and Hospital Admission ? Estela Noyola DO, Rahul Ramesh MD, Joshua Chan, MD, Asif Noor MD and Leonard R. Krilov MD Children’s Medical Center at NYU Winthrop Hospital

INTRODUCTION RESULTS SUMMARY • Elevated immature neutrophil percentage (> 10 %) or bandemia is used • A total of 477 pediatric patients were retrospectively enrolled into the study, for a by some clinicians as a sign of serious bacterial . total of 498 unique admissions. • In 1991, the Society of Critical Care Management came out with the TABLE 1: Comparison of viral versus bacterial TABLE 2: Bandemia (Bands ≥ 10%) in viral infection recommendation that bandemia of greater than 10% should be one of the P- • Patients with bacterial infection were significantly younger than patients with criteria for systemic inflammatory response syndrome (SIRS). Clinicians, Viral Bacterial Total P-value Bands < 10% Bands ≥ 10% Total value viral infection. since then, have been using bands higher than 10% as an indication of Number of ED Admissions 456 42 498 bacterial illness. Number of Participants 394 58 452 • Patients with bacterial infection had a significantly higher mean WBC, • However, bands can also be elevated in a number of viral infections and Age (Months) 16.8 (7.4 - 31.2) 7.1 (4.0 - 26.7) 15.9 (6.3 - 31.0) 0.004 16.9 (6.5 - 16.9 (7.4 - significantly higher mean neutrophil count, significantly lower stressful situations such as trauma. Female (N, %) 228 (50.0%) 25 (59.5%) 253 (50.8%) 0.262 Age (Months) 31.1) 16.5 (8.4 - 36.9) 31.2) 0.464 proportion, and significantly higher exposure to antibiotics than patients with viral • We sought to compare the mean band percentage in children with 4297 (2745 - 5973 (4046 - 4595 (2837 - infection (Table 1). Fever at presentation (Days) 2.0 (1.0 - 4.0) 1.0 (1.0 - 3.0) 2.0 (1.0 - 4.0) 0.061 confirmed viral infections to those with bacterial infections. ANC 7590) 8909) 7834) 0.006 • In the viral group, patients with bands proportion ≥10% had significantly higher Initial Temperature (oF) 100.7 ± 2.1 100.6 ± 2.4 100.7 ± 2.1 0.808 mean temperature, significantly lower mean lymphocyte count, significantly lower Lymphocyte Proportion 41.1 ± 18.9 30.5 ± 13.8 39.8 ± 18.7 < 0.001 HYPOTHESIS WBC Absolute (1000K/uL) 11.6 ± 5.7 16.8 ± 7.5 12.1 ± 6.0 < 0.001 mean lymphocyte proportion, significantly higher exposure to antibiotics, and significantly higher rate of admission than their viral counterpart with bands A) Higher band proportion in children with bacterial infections as compared A/T Ratio 0.1 ± 0.1 0.2 ± 0.1 0.1 ± 0.1 < 0.001 to viral infections Band Proportion 3.8 ± 4.7 3.8 ± 4.8 3.8 ± 4.7 0.983 Antibiotics Given (N, %) proportion < 10% (Table 2). B) Higher antibiotic use in children with confirmed viral infection based on 118 (29.9%) 37 (63.8%) 155 (34.3%) < 0.001 •In the viral group, a high antibiotic use was seen with Metapneumovirus Neutrophil Absolute 5.6 ± 4.3 7.4 ± 4.1 5.7 ± 4.3 0.010 bandemia alone Admission to Hospital CONCLUSIONS Neutrophil Proportion 45.6 ± 19.6 48.5 ± 18.4 45.9 ± 19.5 0.367 (N, %) 174 (44.2%) 37 (63.8%) 211 (46.7%) 0.007 A) We did not find any difference in band proportion between the viral and METHODS 4604 8638 4740 A retrospective chart review was conducted on children between the ages ANC (2844 - 7834) (4950 - 11700) (2916 - 8083) < 0.001 TABLE 3 : Bandemia and antibiotic use in specific viruses the bacterial group. Virus Bands ≥ 5% Antibiotics Given P-value of ≥ 1 month and ≤ 5 years seen at Winthrop University Hospital’s Lymphocyte Absolute 4.6 ± 4.4 5.7 ± 4.1 4.7 ± 4.4 0.107 B) Children with confirmed viral infection and band proportion > 10% were st th emergency department from January 1 , 2016 through January 1 , 2017. more likely to get antibiotic and hospital admission. We reviewed complete counts (CBC) in two groups. Lymphocyte Proportion 39.7 ± 18.6 36.9 ± 16.2 39.5 ± 18.4 0.334 Influenza 26 (30.2%) 35 (40.7%) 0.165 Group 1: Febrile children with confirmed viral infection Monocyte Absolute 1.0 ± 0.8 1.2 ± 1.0 1.0 ± 0.8 0.469 C) In the viral group higher rate REFERENCESof antibiotic use was seen in children with Group 2: Febrile children with confirmed bacterial infection Parainfluenza 18 (17.8%) 34 (33.7%) 0.659 metapneumovirus. (bacteremia, urinary tract infection, meningitis, enteritis). Monocyte Proportion 9.3 ± 4.9 6.8 ± 5.3 9.0 ± 5.0 0.003 •Kuppermann N, Walton EA. Immature neutrophils in the blood smears of young febrile children. Arch Pediatr Adolesc We included children with fevers and a film array positive for Adenovirus, Antibiotics Given (N, %) 155 (34.0%) 39 (92.9%) 194 (39.0%) < 0.001 Med.1999 Mar;153(3):261-6 RSV, Parainfluenza, Influenza and Metapnuemovirus. We excluded . Metapneumovirus 27 (42.2%) 31 (47.7%) 0.016 Admission to Hospital (N, %) 211 (46.3%) 26 (61.9%) 237 (47.6%) 0.055 enterovirus and rhinovirus for two reasons. Firstly, its detection in an •JORG D. SEEBACH, MD,1 RUDOLF MORANT, MD,1 REGULA RUEGG,1 BURKHARDT SEIFERT, PhD, AND Length of Stay (Days) 3.0 (2.0 - 4.0) 3.0 (3.0 - 4.0) 3.0 (2.0 - 4.0) 0.115 Adenovirus 19 (33.9%) 18 (30.5%) 0.659 JORG FEH MD. The diagnositic value of neutrophils left shift in infectious and inflammatory condictions. AJCP, October asymptomatic child may imply colonization or asymptomatic shedding. 16, 1996. Secondly, they are reported together as enterovirus/rhinovirus. We also RSV 54 (31.4%) 46 (26.7 %) 0.011 excluded coronavirus as a majority of the cases were either asymptomatic Readmission within 30 days •Tracey Anne Mare1,2, David Floyd Treacher1,2, Manu Shankar-Hari1,2, Richard Beale1,2, Sion Marc Lewis1,2,4,David (N, %) 10 (2.2%) 0 (0.0%) 10 (2.0%) 0.999 John Chambers3 and Kenneth Alun Brown1,2,4. The diagnostic and prognostic significance ofmonitoring blood levels of or mild upper respiratory symptoms. immature neutrophils in patients with systemic . Mare et al. Critical Care (2015) 19:57 The study was approved by Winthrop IRB. Template provided by: “posters4research.com”