158. Molecular Detection of Human Rhinovirus in Hospitalized Kansas City Children (2009-2012): Demographics, Chest Radiograph Findings and Length of Stay in Relation to Pre-existing Comorbidity.
Session: Poster Abstract Session: Big Viruses in Little People (Pediatric Viral Diseases)
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • HRV poster IDSA 2016 10102016 for printing.pdf (561.9 kB)
  • Background: Human rhinovirus (HRV) is the pediatric respiratory virus most often detected by routine molecular diagnostics. The relevance/utility of HRV detection remains unclear. We performed a 40-month retrospective review of hospitalized children (Jan 2009-May 2012).

    Methods: Multiplex PCR testing detected >1 virus in 2375 patients (1290 HRV/enterovirus (EV)). Excluding nosocomial HRV, confirmed EV, NICU/immunocompromised patients, and charts with missing data, 617 charts were reviewed. Chest X-rays (CXR) were interpreted by a blinded pediatric radiologist. Admission groups and definition: 1. Bacterial N= 72 (11.7%): confirmed serious bacterial infection (SBI); 2. Equivocal N=37 (5.6%): pneumonia unconfirmed as bacterial or viral; 3. Nonbacterial N=509 (82.6%). Pre-existing co-morbidities were noted in 154/617.Results: HRV was the sole virus in 85%. Peak HRV detection was Mar-May and Sept-Nov. Male/female ratio was 329/288; 76% were <3 yrs old. There were 55 PICU stays (15 bacterial and 35 nonbacterial). HRV results were available at Mn 1.54d (0-8.5) post admit but returned after hospital discharge (D/C) for 177/617.

    For all 509 nonbacterial admits, the D/C rate by 48hr after HRV results were available was 46% and Mn length of stay (LOS) was 8.1d (range 0-402d, St Dev +27.3). For the N=439 with HRV results available to clinicians before patient D/C, the D/C rate was 57% and LOS 8.2d (0-196, +13.6). The D/C rates at both 24hr and 48hr after HRV-results became available were less, p<0.001, for patients with pre-existing co-morbidity (23.7% and 33%) vs for previously healthy patients (57.4% and 67% respectively). A co-morbidity effect on D/C rate and LOS held true for PICU admits (p=0.02). CXR on 386 patients (SBIs excluded) showed 74 normal, 2 atelectasis only, 211 viral pattern, 25 bacterial pattern, and 74 mixed pattern. CXR suggested underlying chronic lung disease in 39 and congenital heart disease in 31.

    Conclusion: Almost 90% of non-SBI admits had HRV as the sole detected pathogen (70%of PICU cases). 3/4 of HRV occurred in children <3 years old. Molecularly detected HRV was associated with early D/C for previously healthy children. During admission, CXR patterns in almost 2/3 HRV patients were inconsistent with a bacterial process. HRV seems an important pathogen in hospitalized, even previously healthy, children. Our data may allow less antibiotic use and early discharge.

    Christopher Harrison, M.D., FAAP, FPIDS, Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO, Nasreen Quadri, MD, Departments of Internal Medicine and Pediatrics, University of Minnesota, Minneapolis, MN, Amy Dahl, MD, Radiology, Children's Mercy Hospital Kansas City, Kansas City, MO and Rangaraj Selvarangan, PhD, Children's Mercy Hospital and Clinics, Kansas City, MO

    Disclosures:

    C. Harrison, Alios: Investigator , Research support
    Regeneron: Investigator , Research support
    GSK: Investigator , Research grant
    Roche: Investigator , Research support
    CDC: Investigator , Research grant

    N. Quadri, None

    A. Dahl, None

    R. Selvarangan, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.