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Coinfection with rhinovirus appears to lengthen hospital stay
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DENVER — Children who are infected with rhinovirus plus another respiratory virus appear to have longer hospital stays, according to new study data presented here.
In a large, multicenter study of children hospitalized with bronchiolitis, respiratory syncytial virus (RSV) was the most common viral etiology, but rhinovirus was present in approximately one-quarter of children. While there were no apparent short-term clinical differences in intensive care interventions between single virus infections, nearly one in three children had multiple virus infections — most of which were rhinovirus.
“Rhinovirus is a key virus that we will be talking about for the next 10 years. Hospitals should consider adding rhinovirus to the viral panels because they could affect length of stay,” said Jonathan M. Mansbach, MD, of Children’s Hospital Boston and Massachusetts General Hospital, who presented the findings during the 2011 Pediatric Academic Societies’ Annual Meeting, where more than 7,900 pediatricians gathered to present their research. “This high frequency of viral co-infections raises questions about the effectiveness of current RSV-based cohorting practices.”
Because the viral etiology of a severe bronchiolitis is of uncertain clinical relevance for inpatient care, Mansbach and colleagues designed a study to examine if specific single or multiple viral infections affect intensive care interventions in children hospitalized with bronchiolitis.
The study results revealed that specific virus combinations may affect clinical outcomes and warrant further investigation.
The prospective cohort study in 16 centers included hospitalized children aged younger than 2 years with a physician diagnosis of bronchiolitis. For three consecutive years beginning in 2007, researchers collected clinical data and a nasopharyngeal aspirate between Nov. 1 and March 31. Intensive care unit (ICU) visits were oversampled.
“PCR testing for 15 viruses and two bacteria is ongoing, but this analysis focuses on four viruses with complete testing: RSV-A, RSV-B, rhinovirus and human metapneumovirus,” Mansbach said, adding that the analysis was based on data as of Nov. 1, 2010.
Of the 2,207 enrolled children, 377 (17%) were admitted to the ICU, and 160 were intubated or had continuous positive airway pressure. The median age of patients was 4 months and 60% were male; 62% were white, 25% black and 36% Hispanic.
Based on the latest data, 8% (95%CI, 6-9) had no virus isolated, 66% (95% CI, 64-68) had single virus infections and 26% (95% CI, 24-28) had multiple virus infections. Among those with more than one identified virus, the most commonly detected viruses included: RSV-A (46%), RSV-B (32%), rhinovirus (27%) and human metapneumovirus (7%) (co-infections explain sum to more than 100%), according to Mansbach.
At least one other virus was detected in 29% (95%CI, 27-32) of RSV-A infections, 30% (95%CI, 26-33) of RSV-B infections, 67% (95%CI, 63-71) of rhinovirus infections and 44% (95%CI, 36-52) of metapneumovirus infections.
“Children with rhinovirus alone had a short length of stay. But when you combine rhinovirus with another virus, these children had longer length of stay. There was no difference in length of stay with RSV combined with other viruses,” Mansbach said.
Length of hospital stay, ICU admission, and intubation/continuous positive airway pressure did not vary by presence or absence of each virus (all P>.01). Mansbach said these results many have limited generalizability to outpatients because the study was conducted among inpatients.
A follow-up study is being planned that will include 10 sites and enroll 1,000 children, according to Mansbach.
Disclosures: Dr. Mansbach reports no relevant financial disclosures.
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