Frequency and Clinical Outcome of Respiratory Viral Infections and Mixed Viral-bacterial Infections in Children With Cancer, Fever and Neutropenia

Abstract

RVIs were the most frequently detected agents irrespective of their initial risk assessment for IBI. The clinical outcome of mixed RVI was similar to sole RVI episodes as well as for bacterial infections compared with mixed viral-bacterial infections. Systematic and early detection of RVI in children with cancer and FN might help to optimize their management by reducing hospitalization and antimicrobial use.

The frequency of influenza and bacterial coinfection: a systematic review and meta‐analysis

“…The full‐text review resulted in the exclusion of an additional 74 articles. A total of 27 articles encompassing 3215 patients met all the inclusion criteria and were included in the final analysis 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54. Of those 27, only eight studies, with 334 patients, provided the numbers or percentages of each bacterial coinfecting pathogen 28, 32, 33, 34, 38, 43, 46, 47.…”

“…All 27 included studies were observational, of which 13 (1218 patients) were prospective studies,30, 32, 33, 36, 40, 41, 43, 44, 48, 49, 50, 51, 52 and 14 (1997 patients) were retrospective analyses (Table 1). The majority (21) of studies were cohort studies, and the rest were case–control studies.…”

“…Most studies enrolled only adults, although the lower age cutoffs varied (e.g., some studies considered adults older than 14 while others used 21). Only seven studies (1214 patients) focused on young children or newborns,29, 31, 38, 46, 49, 51, 54 and two studies (504 patients) included both children and adults 42, 53. Severity of illness varied among studies, but all were focused on hospitalized patients, suggesting a greater than average severity.…”

“…Severity of illness varied among studies, but all were focused on hospitalized patients, suggesting a greater than average severity. Eleven of the studies (1007 patients) focused exclusively on patients initially enrolled in an intensive care unit (ICU),32, 34, 35, 38, 39, 41, 42, 44, 46, 47, 51 10 enrolled non‐ICU hospitalized patients (973 patients),30, 33, 36, 37, 40, 43, 45, 49, 53, 54 3 enrolled patients in the emergency department (ED; 135 patients),28, 48, 50 and 2 enrolled patients in a mix of inpatient and outpatient settings (1100 patients) 29, 52. The median sample size was 51 (IQR, 18·5–101), and the mean was 119 (SD: 203), which was driven by three large studies29, 44, 53 that contributed 1958 (61%) of the total number of patients included in this analysis.…”

“…Only four studies explicitly measured and reported on comorbidities of patients with coinfection and found that older age,28, 44, 53 a higher APACHE II (Acute Physiology and Chronic Health Evaluation II) score,44, 53 diabetes,33 and sepsis33 were risk factors for coinfection. Further, some studies only included severely immunocompromised patients who had concurrent malignancy or organ transplant,31, 33, 49 while others excluded immunocompromised patients. Severity of illness however was not a factor that could be standardized among the studies.…”