Epidemiology, disease course and outcome comparison of children
hospitalized with single versus multiple respiratory viral
co-infections: A Single-Center Retrospective Cohort Study.
Introduction: Respiratory viral infections cause a significant morbidity
in children. Significance of isolation of multiple viruses in acute
lower respiratory infections (ALRI) in children is not well
characterized. The aim of this study was to compare demographics,
resource utilization, and outcomes of patients with single versus
multiple viral co-infections. Methods: This retrospective study was
conducted by reviewing electronic records of patients hospitalized with
positive respiratory viral panel within 48 hours of admission from
1/1/2015 to 12/31/2019. Outcome assessment included resource
utilization, length of stay and costs. Univariate and multivariable
analysis were performed. Results: A total of 2192 patients were included
in this study. 16.4% of all patients had viral co-infections.
Rhino/enterovirus comprised 49.2% of all identified viruses.
Rhino/enterovirus and RSV were the most common co-infections (22.4%).
Patients with coinfection were younger in age (median11.3 months).
Intravenous antibiotics were prescribed in 29.4% with no difference in
usage among the two groups. Patients with viral coinfections had a
higher rate of high flow nasal cannula utilization, intubation, and
length of stay (3 days [1,5] vs 2 days [1,4]). Overall mortality
rate of study population was 0.3% with no difference between the two
groups. Cost of care was higher for patients with coinfection but not
significant after adjusting for confounders. Conclusion: Children with
viral coinfection comprise a sizeable proportion of hospitalized
children with bronchiolitis and have a higher severity of illness as
suggested by increased use of high flow nasal cannula and hospital
length of stay.