1231. Detection of Respiratory Co-Infections in Pediatric Patients using FilmArray®: Evidence for Combined Droplet and Contact Isolation
Session: Poster Abstract Session: RSV and Other Viral Respiratory Infections in Children
Saturday, October 22, 2011
Room: Poster Hall B1
Background: In Fall 2009, Children’s Hospital of Michigan instituted combined isolation precaution policy (dual contact and droplet isolation precautions) for all inpatients with respiratory infection symptoms, in light of the 2009 H1N1 pandemic.  Determination of appropriate isolation precautions for hospitalized patients with potential respiratory co-infection is an important intervention to prevent nosocomial transmission.

Methods: Pediatric patients with at least one or more signs or symptoms suggestive of respiratory tract infection (fever, cough, sore throat, runny nose, myalgia, earache, headache, chills or fatigue) had nasopharyngeal (NP) swab samples obtained January – December 2010 for FilmArray® Respiratory Panel multiplex nucleic acid testing for simultaneous qualitative detection and identification of 20 common or emerging respiratory pathogens.

Results: Of 510 NP samples, 347 (68%) had at least one pathogen identified.  The most frequently identified pathogen was rhinovirus/enterovirus (R/E) (188/347= 54%) for which no rapid antigen testing exists at our center.  Of the 347 samples with at least one identified pathogen, 58/347 (17%) had two pathogens.  In those 58 patients, the most common dual co-infections were R/E and Respiratory Syncytial Virus (RSV) 11/58 (19%), R/E and adenovirus 8/58 (14%), R/E and bocavirus 7/58 (12%), R/E with human metapneumovirus (hMpV) 6/58 (10%), and RSV with bocavirus 4/58 (7%).  Of the 347 with at least one positive result, 8 (2%) samples were positive for 3 pathogens.  Two of these 8 included R/E, RSV and bocavirus; one included R/E, adenovirus and bocavirus; one had R/E, hMpV and bocavirus.  Over half of the 64 patients who had more than one pathogen would have required combined (dual contact and droplet isolation) precautions.  

Conclusion: Pediatric patients with respiratory symptoms may have negative rapid antigen tests for common viral pathogens but could be infected with other circulating pathogens, namely rhinoviruses.  Co-infection with two to three pathogens occurred in nearly 20% of our patients who had at least one pathogen and these co-infections were frequently seen in combinations requiring dual contact and droplet precautions.      


Subject Category: P. Pediatric and perinatal infections

Eric McGrath, MD1, Marilynn Fairfax, MD/PhD2, Paul Lephart, PhD3, Jamal Ameli, MD, CCRP4, Nahed Abdel-Haq, MD1, Basim Asmar, MD5 and Hossein Salimnia, PhD6, (1)Children's Hospital of Michigan, Wayne State University, Detroit, MI, (2)Wayne State University, Detroit, MI, (3)DMC University Laboratories, Detroit, MI, (4)Children's Hospital of Michigan, Detroit, MI, (5)Pediatrics/ Pediatric Infectious Diseases, Children's Hospital of Michigan, Wayne State University, Detroit, MI, (6)Detroit Medical Center, Wayne State University, Detroit, MI

Disclosures:

E. McGrath, None

M. Fairfax, None

P. Lephart, None

J. Ameli, None

N. Abdel-Haq, None

B. Asmar, None

H. Salimnia, Idaho Technology: Grant Investigator, Research grant
Astellas Pharma.: Grant Investigator, Research grant
AdvanDx: Grant Investigator, Research grant

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