Impact of the francophone pediatric intensive care group bronchiolitis recommendations on diagnostic testing, antibiotic therapy and patient prognosis.

BACKGROUND

Acute bronchiolitis is a common viral infection in infants, with severe cases requiring admission to pediatric intensive care units (PICU). While bacterial co-infections are rare, timely diagnosis and management are essential. Updated guidelines from the French-speaking Group of Pediatric Intensive and Emergency Care (GFRUP) aim to standardize the standard of care, reducing unnecessary interventions.

OBJECTIVES

This study evaluated the impact of updated bronchiolitis management guidelines on sepsis incidence, diagnostic test use, and antibiotic prescriptions in a single center.

METHODS AND SETTINGS: A retrospective study compared two epidemic periods (2022-2023 and 2023-2024) at the PICU, Necker-Enfants Malades Hospital. Clinical and microbiological data, including sepsis incidence, bacterial co-infections, diagnostic tests, and antibiotic use, were analyzed.

RESULTS

Among 257 infants admitted for bronchiolitis, sepsis incidence remained low (8% vs. 7%). Implementation of the guidelines led to a significant reduction in additional diagnostic tests (65% vs. 49%, p = 0.013). Antibiotic prescription rates were unchanged, but a narrower spectrum of antibiotics was observed, with decreased amoxicillin/clavulanate use and increased amoxicillin prescriptions. Lung infections were the most frequent bacterial co-infections, with no rise in bacterial infection rates.

CONCLUSIONS

Implementation of updated guidelines reduced unnecessary diagnostic tests and promoted narrower-spectrum antibiotic use without increasing sepsis incidence. These findings highlight the potential of evidence-based guidelines to optimize care, support antibiotic stewardship, and minimize unnecessary interventions in pediatric critical care.