# Antibiotic Therapy and Factors Predicting Prolonged Hospitalization Among Children Under Three Years Diagnosed With Respiratory Syncytial Virus‐Associated Lower Respiratory Infection

## TL;DR

This study examines antibiotic use and factors linked to longer hospital stays in young children with RSV-related lung infections.

## Contribution

The study identifies antibiotic therapy as a key predictor of prolonged hospitalization in RSV-associated lower respiratory infections in children.

## Key findings

- 90.74% of children with RSV-LRI received antibiotics, which was linked to longer hospital stays.
- Younger age, pneumonia, and lower oxygen levels at admission predicted longer hospitalization.
- Antibiotic use increased the odds of a hospital stay of five days or more by sevenfold.

## Abstract

Respiratory syncytial virus (RSV) is a common cause of lower respiratory infections (LRIs) in infants and young children. Antibiotic overuse remains a significant concern in hospitalized children with RSV‐associated LRIs. This study aimed to investigate the prevalence of antibiotic use and identify predictors of prolonged hospitalization in children with RSV‐LRIs.

A retrospective record review study was conducted at Abha Maternity and Children's Hospital, enrolling 162 children aged 1–36 months admitted with RSV‐associated LRIs between January and December 2022. Demographic, clinical, laboratory, and imaging data were collected. Antibiotic therapy and hospital length of stay (LOS) were also retrieved and analyzed.

Of the 162 patients, 147 (90.74%) received antibiotic therapy, with azithromycin, cefuroxime, and ceftriaxone being the most commonly used. Patients who received antibiotics had a significantly longer median LOS compared to those who did not (6 vs. 3 days, p < 0.001). Factors associated with prolonged LOS (≥ 5 days) included antibiotic therapy use (odds ratio [OR] = 7.47 (95% confidence intervals [CI]: 2.18−25.57), pneumonia: OR = 3.58 (95% CI: 1.67−7.67), age < 12 months: OR = 2.80 (95% CI: 1.32−5.89), consolidation: OR = 2.54 (95% CI: 1.16−5.59), age in months: OR = 0.94 (95% CI: 0.91−0.98) (indicates decreasing odds with increasing age), admission respiratory rate: OR = 1.04 (95% CI: 1.01−1.07), and admission peripheral oxygen saturation (SpO2): OR = 0.91 (95% CI: 0.86−0.97) (indicates decreasing odds with higher SpO2).

The high prevalence of antibiotic use in this study highlights the challenges in differentiating RSV‐LRIs from bacterial pneumonia. Independent predictors of prolonged hospital stay included antibiotic therapy, pneumonia, younger age, lower admission SpO₂, and higher respiratory rate.