Room Sharing in Hospitalized Children With Bronchiolitis and the Occurrence of Hospital-Acquired Infections: A Prospective Cohort Study

Analysis of Pathogens in Respiratory Tract Infections and Their Effect on Disease Severity: Retrospective Data from a Tertiary Care German Children's Hospital

BACKGROUND

Respiratory tract infections (RTIs) represent a frequent cause of inpatient admission in children's hospitals, especially in the fall and winter seasons, resulting in major healthcare problems due to a lack of beds. The age and seasonal distribution of each pathogen seem to be multifactorial features that influence the course of infection. Other severity predictors appear to be the length of hospital stay, the presence or absence of oxygen demand, and the value of inflammatory markers.

METHODS

All inpatients from our children's hospital between 2021 and 2023 who had a nasopharyngeal swab and presented with RTI symptoms were recruited for this retrospective cohort study. The parameters of interest were age, swab result, month of detection, CRP values, duration of hospitalization, presence of oxygen demand, and comorbidities. The data were analyzed using chi-square tests, paired t-tests and regression analysis to determine the associations of differences between the groups.

RESULTS

Detection of more than one respiratory pathogen in the same swab, apart from combinations with SARA-CoV-2, influenza, or RS-virus, was not associated with longer hospital stay, higher mean maximal CRP values, or oxygen demand compared to mono-infection with the same pathogens. In contrast, the detection of a pathogen versus no detection could be related to higher rates of oxygen demand and higher CRP values.

CONCLUSIONS

Since co-infection with more than one virus, excluding those with epidemic potential, was not associated with a more severe course of RTIs, strict patient isolation seems to be dispensable for several viruses, as well as isolation of infected or colonized patients.

Secondary Attack of Symptomatic SARS-CoV-2 Infections Among Roommates in a Children's Hospital

BACKGROUND

SARS-CoV-2 can potentially cause nosocomial outbreaks. Although high secondary attack rates (SARs) among adult roommates have been reported, data on pediatric settings are limited. This study aimed to evaluate the SAR of symptomatic SARS-CoV-2 infections in shared rooms in a children's hospital.

METHODS

A retrospective chart review from January 1, 2023, to December 31, 2023, was conducted at the National Center for Child Health and Development, one of the largest tertiary children's hospitals in Japan. According to hospital policy, nucleic acid amplification tests for SARS-CoV-2 were required for all hospitalized patients who developed new-onset fever or respiratory symptoms during the study period. If the test result was positive, confirmed cases with SARS-CoV-2 infection were immediately transferred to an isolation ward, and their remaining roommates were closely monitored for 5 days following the diagnosis of the index case. The SAR of symptomatic SARS-CoV-2 infections among roommates was calculated.

RESULTS

Eighteen patients were identified as index cases with whom a total of 53 roommates had contact. Among these exposed roommates, secondary symptomatic SARS-CoV-2 infections occurred in 2 shared rooms, and the SAR within 5 days after the exposure from the index case was 5.7% (3/53).

CONCLUSIONS

The SAR of symptomatic SARS-CoV-2 infections in the largest tertiary children's hospital in Japan was not high in this study. Further studies are warranted to validate our findings and to establish effective isolation and surveillance strategies for SARS-CoV-2 in hospitalized children.

High-flow oxygen therapy in moderate to severe bronchiolitis: a randomised controlled trial

BACKGROUND AND OBJECTIVE

High-flow (HF) oxygen therapy is being used increasingly in infants with bronchiolitis, despite lack of convincing evidence of its superiority over low flow (LF). We aimed to compare the effect of HF to LF in moderate to severe bronchiolitis.

METHODS

Multicentre randomised controlled trial during four winter seasons (2016-2020) including 107 children under 2 years of age admitted with moderate to severe bronchiolitis, oxygen saturation of <92% and severely impaired vital signs. Crossovers were not allowed. HF was administered at flow rates of 2 L/kg for the first 10 kg, plus 0.5 L/kg for every kg >10 kg, LF with a maximum flow rate of 3 L/min. Primary outcome was improvement of vital signs and dyspnoea severity within 24 hours assessed by a composite score. Secondary outcomes were comfort, duration of oxygen therapy, supplemental feedings, hospitalisation duration and intensive care admission for invasive ventilation.

RESULTS

Significant improvement within 24 hours occurred in 73% of 55 patients randomised to HF and in 78% of 52 patients with LF (difference 6%, 95% CI -13% to 23%). Intention-to-treat analysis revealed no significant differences in any secondary outcome: duration of oxygen therapy, supplemental feedings, hospitalisation and need for invasive ventilation or intensive care admission, except for comfort (face, legs, activity, cry, consolability), which was one point (out of a scale of 0-10) higher in the LF group. No adverse effects occurred.

CONCLUSION

We found no measurable clinically relevant benefit in the use of HF compared with LF in hypoxic children with moderate to severe bronchiolitis.

TRIAL REGISTRATION NUMBER

NCT02913040.

Healthcare-associated viral respiratory infections in paediatric intensive care unit settings: More than just a sneeze

Healthcare-associated infections (HAIs) affect patient health. Patients with Paediatric Intensive Care Unit (PICU) acquired viral respiratory infections had longer use of respiratory support. We found it's uncommon in ICUs to have high risk HAIs. RSV, parainfluenza, and hMPV are the most common, and 1/3 of patients required escalation in respiratory support and/or escalation in antibiotics. All patients had underlying comorbidities. In our series there were two deaths within 2 weeks of infection.

Prevalence and Risk Factors of Respiratory Syncytial Virus in Children under 5 Years of Age in the WHO European Region: A Systematic Review and Meta-Analysis

A respiratory syncytial virus (RSV) is the major cause of respiratory tract infection in children under 5 years. However, RSV infection in the European Region of the World Health Organization has not been systematically reviewed. The aim was to determine the prevalence and factors associated with RSV in children under 5 years of age in European regions. A systematic review and meta-analysis was performed. CINAHL, Medline, LILACS, ProQuest, SciELO, and Scopus databases were consulted for studies published in the last 5 years, following Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The search equation was "respiratory syncytial virus AND (newborn OR infant OR child) AND (prevalence OR risk factors)". Studies reporting the prevalence of RSV were eligible for inclusion in the meta-analysis. A total of 20 articles were included. The meta-analytic prevalence estimation of RSV, with a sample of n = 16,115 children, was 46% (95% CI 34-59%). The main risk factors were age, male gender, winter season, and environmental factors such as cold temperatures, higher relative humidity, high concentrations of benzene, exposure to tobacco, and living in urban areas. Robust age-specific estimates of RSV infection in healthy children should be promoted in order to determine the optimal age for immunization. In addition, it is necessary to analyse in greater depth the potentially predictive factors of RSV infection, to be included in prevention strategies.

Systematic review and meta-analysis of the prevalence of common respiratory viruses in children < 2 years with bronchiolitis in the pre-COVID-19 pandemic era

INTRODUCTION

The advent of genome amplification assays has allowed description of new respiratory viruses and to reconsider the role played by certain respiratory viruses in bronchiolitis. This systematic review and meta-analysis was initiated to clarify the prevalence of respiratory viruses in children with bronchiolitis in the pre-COVID-19 pandemic era.

METHODS

We performed an electronic search through Pubmed and Global Index Medicus databases. We included observational studies reporting the detection rate of common respiratory viruses in children with bronchiolitis using molecular assays. Data was extracted and the quality of the included articles was assessed. We conducted sensitivity, subgroups, publication bias, and heterogeneity analyses using a random effect model.

RESULTS

The final meta-analysis included 51 studies. Human respiratory syncytial virus (HRSV) was largely the most commonly detected virus 59.2%; 95% CI [54.7; 63.6]). The second predominant virus was Rhinovirus (RV) 19.3%; 95% CI [16.7; 22.0]) followed by Human bocavirus (HBoV) 8.2%; 95% CI [5.7; 11.2]). Other reported viruses included Human Adenovirus (HAdV) 6.1%; 95% CI [4.4; 8.0]), Human Metapneumovirus (HMPV) 5.4%; 95% CI [4.4; 6.4]), Human Parainfluenzavirus (HPIV) 5.4%; 95% CI [3.8; 7.3]), Influenza 3.2%; 95% CI [2.2; 4.3], Human Coronavirus (HCoV) 2.9%; 95% CI [2.0; 4.0]), and Enterovirus (EV) 2.9%; 95% CI [1.6; 4.5]). HRSV was the predominant virus involved in multiple detection and most codetections were HRSV + RV 7.1%, 95% CI [4.6; 9.9]) and HRSV + HBoV 4.5%, 95% CI [2.4; 7.3]).

CONCLUSIONS

The present study has shown that HRSV is the main cause of bronchiolitis in children, we also have Rhinovirus, and Bocavirus which also play a significant role. Data on the role played by SARS-CoV-2 in children with acute bronchiolitis is needed.

REVIEW REGISTRATION

PROSPERO, CRD42018116067.

Systematic review and meta-analysis of the prevalence of common respiratory viruses in children < 2 years with bronchiolitis reveal a weak role played by the SARS-CoV-2.. [DOI: 10.1101/2020.08.28.20183681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Introduction The advent of genome amplification assays has allowed description of new respiratory viruses and to reconsider the role played by certain respiratory viruses in bronchiolitis. This systematic review and meta-analysis was initiated to clarify the prevalence of respiratory viruses in children with bronchiolitis in the coronavirus disease 2019 pandemic context.

Methods

We performed an electronic search through Pubmed and Global Index Medicus databases. We included observational studies reporting the detection rate of common respiratory viruses in children with bronchiolitis using molecular assays. Data was extracted and the quality of the included articles was assessed. We conducted sensitivity, subgroups, publication bias, and heterogeneity analyses using a random effect model.

Results

The final meta-analysis included 51 studies. Human respiratory syncytial virus (HRSV) was largely the most commonly detected virus 59.2%; 95% CI [54.7; 63.6]). The second predominant virus was Rhinovirus (RV) 19.3%; 95% CI [16.7; 22.0]) followed by Human bocavirus (HBoV) 8.2%; 95% CI [5.7; 11.2]). Other reported viruses included Human Adenovirus (HAdV) 6.1%; 95% CI [4.4; 8.0]), Human Metapneumovirus (HMPV) 5.4%; 95% CI [4.4; 6.4]), Human Parainfluenzavirus (HPIV) 5.4%; 95% CI [3.8; 7.3]), Influenza 3.2%; 95% CI [2.2; 4.3], mild Human Coronavirus (HCoV) 2.9%; 95% CI [2.0; 4.0]), and Enterovirus (EV) 2.9%; 95% CI [1.6; 4.5]). HRSV was the predominant virus involved in multiple detection and most codetections were HRSV + RV 7.1%, 95% CI [4.6; 9.9]) and HRSV + HBoV 4.5%, 95% CI [2.4; 7.3]).

Conclusions

The present study has shown that HRSV is the main cause of bronchiolitis in children, we also have Rhinovirus, and Bocavirus which also play a significant role. No study has reported the presence of Severe Acute Respiratory Syndrome Coronavirus-2 in children with bronchiolitis to date.

Beyond personal protective equipment: adjunctive methods for control of healthcare-associated respiratory viral infections

PURPOSE OF REVIEW

Prevention of nosocomial transmission of respiratory viruses is a priority in all healthcare settings and often achieved with the use of personal protective equipment. Several adjunctive infection prevention methods are in common use but their effectiveness in reducing healthcare-associated respiratory viral infections is unclear. In this review, recent advances regarding the effectiveness of several adjunctive infection prevention methods to reduce healthcare-associated respiratory viral infections are discussed.

RECENT FINDINGS

Training and education on hand hygiene guidelines, mandatory influenza vaccination for healthcare personnel, access to paid sick leave to reduce ill presenteeism, cohorting of patients with the same infection or clinical syndrome, neuraminidase inhibitor chemoprophylaxis during influenza outbreaks, and enhanced visitor restrictions in pediatric hospitals all have shown some degree of effectiveness in observational or quasi-experimental studies.

SUMMARY

Most of the studies evaluating the effect of adjunctive infection prevention methods on healthcare-associated respiratory viral infections are observational or quasi-experimental and are often combined with other interventions. Therefore, it is difficult to determine the precise effectiveness or efficacy of these interventions and more controlled trials are needed. Multimodal infection prevention policies are likely to be most effective in reducing healthcare-associated respiratory viral infections.