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We compared the need of pediatric intensive care unit (PICU), invasive ventilation, and other respiratory support, viral etiologies, clinical presentations, imaging, and laboratory results in the precovid (2018\u20132019) and covid (2020\u20132022) period. The use of antibiotics was studied with multivariable logistic regression including demographic as well as clinical data as covariates.\u00a0Two hundred fifty-eight patients were enrolled. One hundred fifty-eight patients received an antibiotic (mean duration 6.2 (\u00b12.7) days (median 4; IQR: 4\u20137)). Presence of seizures and C-reactive protein values as predictors for antibiotic prescription (OR for seizures: 12.17; 95% CI: 1.42\u2013103.91; <jats:italic>p<\/jats:italic>\u2009=\u20090.022; OR for CrP: 1.03; 95% CI: 1.01\u20131.04; <jats:italic>p<\/jats:italic>\u2009=\u20090.001). Seventy-four patients received intravenous antibiotics (74\/156, 47.4%). Risk factors for intravenous antibiotic were the presence of decay (OR: 3.74; 95% CI: 1.25\u201311.71; <jats:italic>p<\/jats:italic>\u2009=\u20090.018), CrP values (OR: 1.02; 95% CI: 1.00\u20131.03; <jats:italic>p<\/jats:italic>\u2009=\u20090.001), and presence of seizures (OR: 16.34; 95% CI: 2.65\u2013100.83; <jats:italic>p<\/jats:italic>\u2009=\u20090.003). Duration of intravenous antibiotics correlated with the presence of seizures (Coeff: 1.6; 95% CI: 0.41\u20132.89; <jats:italic>p<\/jats:italic>\u2009=\u20090.009) even when adjusted for CrP values.<\/jats:p><jats:p><jats:italic>\u00a0 \u00a0 Conclusion<\/jats:italic>: The clinical presentation of adenovirus infection in children is non-specific, leading to frequent antibiotic prescription despite bacterial co-infections was rare. Higher CrP values and presenting with seizures are significantly associated with a higher risk of receiving antibiotics. Rapid microbiological tests and newer biomarkers can help clinicians to improve antibiotic prescription in this cohort of children.<\/jats:p><jats:p><jats:table-wrap><jats:table><jats:tbody>\n                    <jats:tr>\n                      <jats:td align=\"left\"><jats:bold>What is Known:<\/jats:bold><jats:bold>\u2022<\/jats:bold><jats:italic>Adenovirus infection is a common cause of fever and respiratory tract infections in children.<\/jats:italic><jats:italic>\u2022<\/jats:italic><jats:italic>Children with adenovirus infections frequently receive antibiotics, but determinants of this practice are poorly established.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                    <jats:tr>\n                      <jats:td align=\"left\"><jats:bold>What is New:<\/jats:bold><jats:bold>\u2022<\/jats:bold><jats:italic> Higher C-reactive protein values and presenting with seizures are significantly associated with antibiotic prescription.<\/jats:italic> \u2022 <jats:italic>Since the beginning of COVID-19 and implementation of rapid diagnostics, less children with adenovirus infection received antibiotics.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                  <\/jats:tbody><\/jats:table><\/jats:table-wrap><\/jats:p>","DOI":"10.1007\/s00431-024-05615-2","type":"journal-article","created":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T06:02:31Z","timestamp":1716444151000},"page":"3489-3497","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Determinants of antibiotic prescription in children with adenovirus respiratory tract infections"],"prefix":"10.1007","volume":"183","author":[{"given":"Danilo","family":"Buonsenso","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Camporesi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Viozzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Lazzareschi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lavinia","family":"Manca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annamaria","family":"Caci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Menna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosaria","family":"Santangelo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Sanguinetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Raffaelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Fiori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Zampino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piero","family":"Valentini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,5,23]]},"reference":[{"key":"5615_CR1","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1159\/000149011","volume":"11","author":"G Wadell","year":"1979","unstructured":"Wadell G (1979) Classification of human adenoviruses by SDS-polyacrylamide gel electrophoresis of structural polypeptides. 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Informed consent was not needed according to local Ethic Committee rules given the retrospective nature of the study using aggregate data.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}