Contrasting definitions and incidence of healthcare-associated respiratory viral infections in a pediatric hospital

Abstract

Objective: To determine the difference in the incidence of healthcare-associated respiratory viral infection (HARVI) in a pediatric hospital depending on the definition used. Design: Descriptive historical cohort study. Setting and participants: Patients aged 0–21 years old who were admitted between July 2013 and June 2018 to a 490-bed primary to quaternary-care pediatric hospital serving northern Texas. Methods: HARVI was defined using microbiologic confirmation, development of new symptoms while hospitalized, and exposure time greater than the minimum incubation period for each specific virus. Events that occurred following the maximum incubation period for that virus were classified as definite, otherwise they were classified as possible. This definition was compared to definitions using alternate timing of onset and symptomatology requirements. Data pertaining to demographics, diagnoses, and illness severity were collected. Results: In total, 498 HARVIs (320 definite and 178 possible) were identified, with an incidence rate of 0.98 per 1,000 patient days (0.63 and 0.35, respectively). Rhinovirus or enterovirus and respiratory syncytial virus were the most identified viruses (58% and 10%, respectively). The median time from admission until HARVI was 10.5 days (interquartile range [IQR], 5–30 days). When alternate definitions were employed, the incidence of HARVI ranged from 0.96 to 2.00 per 1,000 admitted patient days. Conclusions: HARVI remain a common nosocomial infection in pediatric hospitals and the measured incidence is dependent on the definition used. Because of the endemic and pandemic potential of respiratory viruses, standardized definitions are needed to facilitate intra- and interhospital comparisons.

Incidence and outcomes of hospital-associated respiratory virus infections by viral species

“…HARVI incidence varied by viral species and was higher among pediatric patients, similar to previous studies. [7][8][9][10]22,23 For adults, HARVI increased the length of hospital stays and hazard of ICU admission after infection. Hospital-associated influenza infections were also associated with increased risk of in-hospital death for adults.…”

“…However, our use of virus-specific 95th percentile incubation period thresholds to define HARVI is more conservative than most previous studies. 10 In contrast, we may have missed HARVI cases if clinical testing was not performed. Finally, other risk factors for infection and severe outcomes may exist that were not assessed, such as smoking status.…”

“…6 The total burden of hospital-associated respiratory virus infections (HARVI), not just those related to sizeable outbreaks, has increasingly been recognized given the availability and utilization of multiplex respiratory pathogen panels. 7–10…”