HARVI incidence nearly 3 times higher among pediatric patients than adults
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Key takeaways:
- HARVI incidences were 8.8 and 3 per 10,000 admission days for pediatric and adult patients, respectively.
- Cardiovascular and respiratory conditions as well as cancer increased risks for HARVI.
The incidence of hospital-associated respiratory virus infections was higher among pediatric patients compared with adult patients, according to a study of patients at University of Michigan hospitals.
Although some reductions in overall hospital-associated infections have been seen in recent years, studies have shown that rates for most infections at most types of hospitals have been somewhat stagnant.
“Respiratory pathogen panels that can detect many different respiratory viruses are frequently used in inpatient settings. As a result, we now have a better understanding of how often patients are infected with respiratory viruses during their hospital stays,” Joshua G. Petrie PhD, associate research scientist at Marshfield Clinic Research Institute, told Healio. “However, we still don’t have a clear picture of how much respiratory virus infections in the hospital matter.”
According to Petrie, there is a lot of evidence that influenza, RSV, and SARS-CoV-2 infections in the hospital can have “really bad outcomes,” but for viruses like rhinovirus that are often associated with mild cold symptoms “there is a lot less evidence.”
To estimate the incidences of hospital-associated respiratory virus infections (HARVI) among adult and pediatric patients, as well as identify risk factors and outcomes for these patients, Petrie and colleagues conducted a retrospective cohort study using inpatient admissions lasting 24 hours or longer at the University of Michigan adult and pediatric hospitals between 2017 and 2020.
The team calculated HARVI rates and assessed for HARVI risk factors as well as outcomes and status rates including rates of ICU admission, discharge, and in-hospital death.
Overall, the researchers found that HARVI incidences were 8.8 per 10,000 admission days for pediatric patients and 3 per 10,000 admission days for adult patients. The most common viruses identified in adult patients accounting for more than 50% of infections were rhinovirus-enterovirus and influenza A, whereas for pediatric patients, rhinoviruses-enteroviruses were identified in 56% of HARVI cases.
Adult patients had an increased risk for HARVI if they also had congestive heart failure (65% increased risk), renal disease (45%), and cancer (124%), or if they were admitted between September and June vs. July, according to the study. Among pediatric patients, cardiovascular and respiratory conditions, cancer, medical device dependence and admission in December increased HARVI risk.
The study also showed that lengths of stay were longer for adults with HARVI
compared with those without, hospital-associated influenza A was associated with increased risk of death and ICU admissions were increased in the 5 days after HARVI identification. Among pediatric patients, HARVI was not associated with length of stay or death, but as seen in adults, ICU admissions were increased in the 5 days after HARVI identification.
“HARVI still occur despite institutional policies that are aligned to current recommended best practices and can lead to adverse patient outcomes,” Petrie said. “More work can be done to optimize diagnostics and infection control practices to reduce the burden of these infections.”
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