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Risk Factors and Outcomes for Respiratory Syncytial Virusrelated Infections in Immunocompromised Children

Asner, Sandra MD*; Stephens, Derek MSc; Pedulla, Paul BFc*; Richardson, Susan E. MD, FRCPC‡§; Robinson, Joan MD, FRCPC; Allen, Upton MBBS, MSc, FRCPC*

Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e31829dff4d
Original Studies

Background: Respiratory syncytial virus (RSV) is associated with significant morbidity and mortality in immunocompromised children. Data on the risk factors for acquisition and outcomes from RSV infections in this population are limited.

Methods: This cohort study (2006 to 2011) included RSV-positive immunocompromised pediatric inpatients. Nasopharyngeal swabs were tested for RSV by direct immunofluorescence. Purposeful multiple regression was used to assess risk factors associated with community-acquired RSV (CA-RSV) infections and their outcomes compared with nosocomial (N-RSV) infections. Means and medians were compared using Student’s t test and a nonparametric test, respectively. Proportions were compared using χ2 or Fisher’s exact test, as appropriate.

Results: There were 117 RSV-positive patients of whom 42 (35.9%) presented with (N-RSV) infection. Overall, more than a third presented with lower respiratory tract infections, which resulted in a 28% admission rate to the intensive care unit and a mortality rate of 5%; the latter solely among patients with community-acquired infection. Subjects with CA-RSV presented with more advanced clinical evidence of lower tract disease with respiratory distress (eg, intercostal recession; odds ratio 2.5; 95% confidence interval: 1.1–5.6; P = 0.03) compared with those with N-RSV. Subjects with CA-RSV infections were less likely to have a prolonged hospital admission (odds ratio 0.7; 95% confidence interval: 0.5–0.8; P < 0.0001) relative to those with N-RSV infections.

Conclusions: RSV-related infections in immunocompromised children may result in poor outcomes, including mortality. Differences in mortality rates among those with CA-RSV compared with N-RSV warrant further study, with enhanced opportunities for prevention and early detection of infection.

Author Information

From the *Department of Paediatrics, Division of Infectious Diseases, The Hospital for Sick Children, University of Toronto; Research Institute, The Hospital for Sick Children, University of Toronto; Department of Paediatric Laboratory Medicine, Division of Microbiology, The Hospital for Sick Children; §Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto; and Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, Canada.

Accepted for publication May 29, 2013.

This is a Pediatric Investigators Collaborative Network on Infections affiliated project.

This study was funded in part by Abbott Laboratories, Canada, and The Division of Infectious Diseases, Hospital for Sick Children, Toronto, Canada. The funding agency had no role in study design, data collection, analysis and the decision to publish or preparation of the article. The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Upton Allen, MBBS, MSc, FRCPC, Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8. E-mail:

© 2013 by Lippincott Williams & Wilkins, Inc.