Viral respiratory infections acquired during pediatric intensive care unit admission

Abstract

Aims & Objectives: Reduction of nosocomial infections represents an increasingly recognized aspect of Pediatric Intensive Care Unit (PICU) benchmarking. We investigated the incidence and outcomes of acquired viral respiratory infections in children admitted to a PICU with length of stay (LOS) >48 hours. Methods Multicenter, statewide retrospective study including all children (<16-years) requiring PICU admission for >48hours (1-Jan-2008 until 31-Dec-2013). Testing was performed in symptomatic patients using Polymerase Chain Reaction (PCR) capturing nine respiratory viruses. Patients were defined as having a PICU-acquired viral infection if the PCR result was positive after 48hrs of PICU admission until PICU discharge. Duration of intubation and total duration of respiratory support were primary outcomes. Results Of 3,607 patients admitted >48hours to PICU, 102 (2.8%) had a PICU-acquired viral infection, translating into a nosocomial viral infection rate of 0.9/100 PICU patients and 2.8/1000 PICU patient days. Compared to negative/untested patients with PICU LOS >48hrs, those with PICU-acquired viral infections had greater intubation duration (164 versus 67hrs, p<0.001), longer respiratory support (204 versus 68hrs, p<0.001), were more likely to require extracorporeal life support (OR 5.3;2.7-10.3; p<0.001), high-frequency oscillatory ventilation (OR 3.0;1.7-5.4; p<0.001), and inhaled nitric oxide (OR 2.7;1.5-5.0; p=0.001). In multivariate analysis adjusted for LOS, age and PIM2 score, PICU-acquired viral infections were associated with prolonged intubation (p=0.004) and longer total respiratory support(p<0.001). Conclusions The acquisition of a viral infection during PICU admission is associated with significant morbidity, translating into substantial burden to PICU health-care systems. Surveillance and preventative infection control measures for viruses should be considered in PICU quality improvement initiatives.L6238154712018-09-13 <br />