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Bronchiolitis viral etiology associated with hospital length of stay
Viral etiology of bronchiolitis is associated with hospital length of stay, according to recent study findings published in The Pediatric Infectious Disease Journal.
Tuomas Jartti, MD, of the department of pediatrics at Turku University Hospital in Finland, and colleagues evaluated 408 children younger than 2 years diagnosed with bronchiolitis to determine whether the causative virus is associated with duration of bronchiolitis-related hospitalization.
Seventy percent of patients had one virus detected and 15% had two or more viruses.
Respiratory syncytial virus A or B (43%) was the most common pathogen found, followed by rhinovirus (32%); metapneumovirus (7%); parainfluenza virus types 1, 2, or 3 (7%); coronaviruses NL63, HKUI, OC43 or 229E (6%); enteroviruses (3%); and influenza A virus H1N1 or other influenza A viruses (2%).
Overall, 72% of the patients had either RSV and/or rhinovirus. Single infection with RSV was found in 35% of patients, followed by infection caused by neither RSV nor rhinovirus (28%). Infection with rhinovirus only was found in 23% of children in the study, followed by rhinovirus plus non-RSV pathogens in 7%; RSV plus a non-rhinovirus pathogens in 5%; and RSV plus rhinovirus in 2% of enrolled children.
Eighteen percent of patients with rhinovirus and without rhinovirus had a coinfection. Twenty-nine percent of patients with rhinovirus had a coinfection compared with 11% without rhinovirus (P<.001).
Overall, the median length of hospital stay was 2 days; however, 32% of patients were hospitalized for 3 or more days. RSV etiology, young age, prematurity, history of intubation, inadequate oral intake and ICU stay were all associated with a hospital length of stay of 3 or more days. However, a shorter hospital length of stay was associated with rhinovirus etiology.
In a subset of 206 patients younger than 12 months without a history of wheeze, researchers found that 64% were RSV-positive and 14% were rhinovirus-positive. Patients with RSV only were more likely to be hospitalized longer compared with patients with neither RSV nor rhinovirus (P=.002).
“In summary, these multicenter, prospective cohort data show that hospital length of stay is associated with the viral etiology of bronchiolitis,” the researchers wrote. “Children with rhinovirus-only bronchiolitis have a shorter length of stay compared with children with RSV only bronchiolitis. ... Since only 28% of bronchiolitis hospitalizations did not have RSV or rhinovirus, viral diagnostics should focus on these viruses. With regard to clinical research, the differences in hospital length of stay between RSV and rhinovirus infections are clearly relevant confounders when assessing short-term outcomes, eg, in bronchiolitis treatment trials.”
Disclosure: See the study for a full list of disclosures.
