Prospective Multicenter Study of Viral Etiology and Hospital Length of Stay in Children With Severe Bronchiolitis

Abstract

Objective: To determine whether hospital length of stay (LOS) for acute bronchiolitis is influenced by the infecting pathogen.Design: A prospective observational cohort study was performed during 3 consecutive years.Setting: Sixteen US hospitals participated in the study.Participants: Children younger than 2 years hospitalized with bronchiolitis were included.Main Exposure: The results of nasopharyngeal aspirate polymerase chain reaction pathogen testing served as the main exposure.Main Outcome Measure: Hospital LOS was determined.Results: Of 2207 participants, 72.0% had respiratory syncytial virus (RSV) and 25.6% had human rhinovirus (HRV); the incidence of each of the other viruses and bacteria was 7.8% or less. Multiple pathogen infections were present in 29.8% of the children. There were 1866 children (84.5%) with RSV and/or HRV. Among these 1866 children, the median age was 4 months and 59.5% were male. The median LOS was 2 days (interquartile range, 1-4 days). Compared with children who had only RSV, an LOS of 3 or more days was less likely among children with HRV alone (adjusted odds ratio [AOR], 0.36; 95% CI, 0.20-0.63; PϽ .001) and those with HRV plus non-RSV pathogens (AOR, 0.39; 95% CI, 0.23-0.66; PϽ.001) but more likely among children with RSV plus HRV (AOR, 1.33; 95% CI, 1.02-1.73; P=.04), controlling for 15 demographic and clinical factors. Conclusions:In this multicenter study of children hospitalized with bronchiolitis, RSV was the most common virus detected, but HRV was detected in one-quarter of the children. Since 1 in 3 children had multiple virus infections and HRV was associated with LOS, these data challenge the effectiveness of current RSV-based cohorting practices, the sporadic testing for HRV in bronchiolitis research, and current thinking that the infectious etiology of severe bronchiolitis does not affect shortterm outcomes.

Genomic Loads and Genotypes of Respiratory Syncytial Virus: Viral Factors during Lower Respiratory Tract Infection in Chilean Hospitalized Infants

“…This finding may be explained, in part, by the older age of the coinfected group (74.5 vs. 52 days; p = 0.08), but it is also relevant that 80% of these patients had RSV-HRV infection. It has been shown that infants with HRV bronchiolitis are older, and more likely to have asthma-like characteristics [37,38,39], which is also in agreement with the association detected with family history of asthma or atopy in our group with RSV coinfection. …”

Genomic Loads and Genotypes of Respiratory Syncytial Virus: Viral Factors during Lower Respiratory Tract Infection in Chilean Hospitalized Infants

“…This finding may be explained, in part, by the older age of the coinfected group (74.5 vs. 52 days; p = 0.08), but it is also relevant that 80% of these patients had RSV-HRV infection. It has been shown that infants with HRV bronchiolitis are older, and more likely to have asthma-like characteristics [37,38,39], which is also in agreement with the association detected with family history of asthma or atopy in our group with RSV coinfection. …”

Viral aetiology of bronchiolitis in hospitalised children in Qatar

“…However, we found no significant association between single or multiple infections and disease severity or LOS. The findings are consistent with two large studies conducted in North America and Europe [ 13 , 14 ], but in contrast with previous reports where RV was associated with shorter LOS [ 12 , 22 ]. These discrepancies might be related to sample size, study design and variation in host risk factors.…”

Etiology, Seasonality, and Clinical Features of Viral Respiratory Tract Infections in Children Hospitalized With Acute Bronchiolitis: A Single-Center Study

“…Recently, some studies have shown rhinoviruses to be the second most commonly seen pathogen for AB. A study conducted in the United States found a prevalence of 25.6% for rhinovirus, 25 similar to our study. However, other studies reported a lower incidence rate of human rhinoviruses in acute bronchiolitis.…”

Genomic Loads and Genotypes of Respiratory Syncytial Virus: Viral Factors during Lower Respiratory Tract Infection in Chilean Hospitalized Infants

“…This finding may be explained, in part, by the older age of the coinfected group (74.5 vs. 52 days; p = 0.08), but it is also relevant that 80% of these patients had RSV-HRV infection. It has been shown that infants with HRV bronchiolitis are older, and more likely to have asthma-like characteristics [37,38,39], which is also in agreement with the association detected with family history of asthma or atopy in our group with RSV coinfection. …”

Viral aetiology of bronchiolitis in hospitalised children in Qatar

“…However, we found no significant association between single or multiple infections and disease severity or LOS. The findings are consistent with two large studies conducted in North America and Europe [ 13 , 14 ], but in contrast with previous reports where RV was associated with shorter LOS [ 12 , 22 ]. These discrepancies might be related to sample size, study design and variation in host risk factors.…”

Etiology, Seasonality, and Clinical Features of Viral Respiratory Tract Infections in Children Hospitalized With Acute Bronchiolitis: A Single-Center Study

“…Recently, some studies have shown rhinoviruses to be the second most commonly seen pathogen for AB. A study conducted in the United States found a prevalence of 25.6% for rhinovirus, 25 similar to our study. However, other studies reported a lower incidence rate of human rhinoviruses in acute bronchiolitis.…”

Genomic Loads and Genotypes of Respiratory Syncytial Virus: Viral Factors during Lower Respiratory Tract Infection in Chilean Hospitalized Infants

“…This finding may be explained, in part, by the older age of the coinfected group (74.5 vs. 52 days; p = 0.08), but it is also relevant that 80% of these patients had RSV-HRV infection. It has been shown that infants with HRV bronchiolitis are older, and more likely to have asthma-like characteristics [37,38,39], which is also in agreement with the association detected with family history of asthma or atopy in our group with RSV coinfection. …”

Viral aetiology of bronchiolitis in hospitalised children in Qatar

“…However, we found no significant association between single or multiple infections and disease severity or LOS. The findings are consistent with two large studies conducted in North America and Europe [ 13 , 14 ], but in contrast with previous reports where RV was associated with shorter LOS [ 12 , 22 ]. These discrepancies might be related to sample size, study design and variation in host risk factors.…”

Etiology, Seasonality, and Clinical Features of Viral Respiratory Tract Infections in Children Hospitalized With Acute Bronchiolitis: A Single-Center Study

“…Recently, some studies have shown rhinoviruses to be the second most commonly seen pathogen for AB. A study conducted in the United States found a prevalence of 25.6% for rhinovirus, 25 similar to our study. However, other studies reported a lower incidence rate of human rhinoviruses in acute bronchiolitis.…”