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Viral Respiratory Infections Diagnosed After PICU Admission

Moynihan, Katie M., MBBS, FCICM, FRACP1–,3; Barlow, Andrew, Bsc (hons)2; Heney, Claire, FRCPA4; Clark, Julia E., FRACP4; Schlebusch, Sanmarié, FRCPA5; Schlapbach, Luregn J., MD, FCICM2,3,6,7

Pediatric Critical Care Medicine: January 2019 - Volume 20 - Issue 1 - p e46–e50
doi: 10.1097/PCC.0000000000001757
Online Brief Report
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Objectives: Reduction of nosocomial infections represents an increasingly recognized aspect of PICU benchmarking. We investigated the prevalence and outcomes of viral respiratory infections acquired during admission to PICU.

Design: Multicenter, statewide retrospective linkage study.

Setting: Tertiary PICU.

Patients: All children less than 16 years requiring PICU admission for greater than 48 hours from January 1, 2008, until December 31, 2013.

Intervention: Testing was performed in symptomatic patients using an extended panel polymerase chain reaction capturing nine respiratory viruses. Duration of intubation and total duration of respiratory support were primary outcomes.

Measurements and Main Results: Of 3,607 patients admitted to PICU for greater than 48 hours, 102 (2.8%) were diagnosed with a PICU-associated viral infection out of 702 patients (19.4%) undergoing viral testing, reflecting a rate of 2.8 PICU-associated viral infections per 1,000 PICU patient days. Compared with negative/untested patients, those with PICU-associated viral infections had greater intubation duration (median 164 vs 67; p< 0.001), longer respiratory support (204 vs 68 hr; p < 0.001), were more likely to require extracorporeal life support (odds ratio, 5.3; 2.7–10.3; p < 0.001), high-frequency oscillatory ventilation (odds ratio, 3.0; 1.7–5.4; p < 0.001), and inhaled nitric oxide (odds ratio, 2.7; 1.5–5.0; p = 0.001). When comparing patients with PICU-associated viral infection with patients who tested negative for respiratory viruses, no substantial difference in these outcomes was found.

Conclusions: The acquisition of viral infections during PICU admission is less frequent compared with previous reports on bacterial and fungal hospital-acquired infections. We did not observe worse patient-centered outcomes when comparing virus positive versus tested but negative patients. Our findings challenge the clinical value of performing viral respiratory diagnostics in PICU patients evaluated for infection.

1Department of Cardiology, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA.

2Pediatric Intensive Care Unit, Division of Critical Care, Queensland Children’s Hospital, Children’s Health Queensland, Brisbane, QLD, Australia.

3Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.

4Infection Management and Prevention Service, Queensland Children’s Hospital, Children’s Health Queensland, Brisbane, QLD, Australia.

5Mater Pathology, Mater Misericordiae Ltd, Brisbane, QLD, Australia.

6Pediatric Critical Care Research Group, Child Health Research Center, University of Queensland, Brisbane, QLD, Australia.

7Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

Supported, in part, by the Norva Dhalia Grant (College of Intensive Care Medicine) (to Dr. Moynihan).

Dr. Moynihan received funding from a Norva Dhalia grant from the College of Intensive Care Medicine, paid directly for the statistical software. The remaining authors have disclosed that they do not have any potential conflicts of interest.

This study was performed at the Lady Cilento Children’s Hospital, Brisbane, QLD, Australia.

Address requests for reprints to: Luregn J. Schlapbach, MD, FCICM, Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Paediatric Intensive Care Unit, Lady Cilento Children’s Hospital, South Brisbane, QLD 4101, Australia. E-mail l.schlapbach@uq.edu.au

©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies