172. Concomitant Detection of Respiratory Viruses is Associated with Increased Disease Severity in Children with Complicated Pneumonia
Session: Oral Abstract Session: Pediatric Pneumonia
Friday, October 21, 2011: 12:00 PM
Room: 156ABC
Background: Studies have described an association between influenza virus and bacteria in the pathogenesis of lower respiratory tract (LRT) infections. However, the clinical impact of other respiratory viruses in children with complicated pneumonia has not been well characterized. Our objectives were to determine the frequency of viral detection in children with complicated pneumonia and to describe and compare the clinical characteristics and outcomes of those with and without respiratory viruses detected.

Methods: Retrospective review of patients < 21 years of age hospitalized at NCH from January 1, 2006, to April 30, 2011, with complicated pneumonia (defined as parapneumonic effusion or empyema requiring a drainage procedure) who had one or more laboratory tests performed for respiratory viruses. Cases were defined as patients in whom a viral pathogen was identified, and controls were patients who tested negative for viruses.  Each case was matched with two controls for age, sex, race, and bacterial pathogen (S.pneumoniae, S. pyogenes, S. aureus, or none). Demographic, clinical, laboratory, and outcome data were compared between the groups.

Results: Of 222 patients hospitalized with complicated pneumonia during the study period, respiratory virus testing was performed in 95 (43%). A viral pathogen was identified in 26 patients: 12% of all patients and 27% of those with viral testing. Viruses detected included 10 influenza virus, 8 respiratory syncytial virus, 4 parainfluenza virus, 3 human metapneumovirus, and 1 adenovirus. Compared with controls, cases had significantly longer length of stay (13 vs 8.5 days; p<0.01) and days of fever (8 vs 5 days; p<0.01). They were also more likely to have necrotizing pneumonia (OR 4.7; 95% CI: 1.5-14; p<0.01) and require ICU admission (OR 3.4; 95% CI: 1.1-10; p<0.05) or surgical decortication (OR 6.4; 95% CI: 1.5-28; p=0.01).

Conclusion: Viral detection was common in children hospitalized with complicated pneumonia and such patients showed increased disease severity. These findings lend further evidence to the hypothesis of viral-bacterial synergism in LRT disease. Routine implementation of viral testing in this clinical setting may improve patient outcomes when specific antiviral therapies are available.

Subject Category: P. Pediatric and perinatal infections

Rebecca Wallihan, MD1, Asuncion Mejias, MD, PhD1, Douglas Salamon, CLSpMB2, William Barson, MD1, Mario Marcon, PhD2 and Octavio Ramilo, MD1, (1)Department of Pediatrics, Section of Infectious Diseases, Nationwide Children's Hospital (NCH) and The Ohio State University College of Medicine, Columbus, OH, (2)Department of Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH


R. Wallihan, Abbott: Investigator, Research support

A. Mejias, Abbott: Investigator and Speaker's Bureau, Research grant
Mead-Johnson: Investigator, Research grant

D. Salamon, None

W. Barson, None

M. Marcon, Abbott: Investigator, Research support

O. Ramilo, Abbott Labs: Consultant and Scientific Advisor, Consulting fee and Speaker honorarium
Medimmune: Investigator and Scientific Advisor, Research support
Merck : Consultant and Scientific Advisor, Consulting fee
Abbott Molecular: Grant Investigator, Research grant
Quidel: Scientific Advisor, Consulting fee

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