Prospective multicenter study of viral etiology and hospital length of stay in children with severe bronchiolitis

Jonathan M Mansbach, Pedro A Piedra, Stephen J Teach, Ashley F Sullivan, Tate Forgey, Sunday Clark, Janice A Espinola, Carlos A Camargo
Archives of Pediatrics & Adolescent Medicine 2012, 166 (8): 700-6

OBJECTIVE: To determine whether hospital length of stay(LOS) for acute bronchiolitis is influenced by the infecting pathogen.

DESIGN: A prospective observational cohort study was performed during 3 consecutive years.

SETTING: Sixteen US hospitals participated in the study.

PARTICIPANTS: Children younger than 2 years hospitalized with bronchiolitis were included.

MAIN EXPOSURE: The results of nasopharyngeal aspirate polymerase chain reaction pathogen testing served as the main exposure.

MAIN OUTCOME MEASURE: Hospital LOS was determined.

RESULTS: Of 2207 participants, 72.0% had respiratory syncytial virus (RSV) and 25.6% had human rhinovirus(HRV); the incidence of each of the other viruses and bacteria was 7.8% or less. Multiple pathogen infections were present in 29.8% of the children. There were 1866 children(84.5%) with RSV and/or HRV. Among these 1866 children, the median age was 4 months and 59.5% were male. The median LOS was 2 days (interquartile range,1-4 days). Compared with children who had only RSV,an LOS of 3 or more days was less likely among children with HRV alone (adjusted odds ratio [AOR], 0.36; 95%CI, 0.20-0.63; P.001) and those with HRV plus non-RSV pathogens (AOR, 0.39; 95% CI, 0.23-0.66; P.001)but more likely among children with RSV plus HRV(AOR,1.33; 95% CI, 1.02-1.73; P=.04), controlling for 15 demographic and clinical factors.

CONCLUSIONS: In this multicenter study of children hospitalized with bronchiolitis, RSV was the most common virus detected, but HRV was detected in one-quarter of the children. Since 1 in 3 children had multiple virus infections and HRV was associated with LOS, these data challenge the effectiveness of current RSV-based cohorting practices, the sporadic testing for HRV in bronchiolitis research, and current thinking that the infectious etiology of severe bronchiolitis does not affect short-term outcomes.

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