Nosocomial infection: a risk factor for a complicated course in children with respiratory syncytial virus infection--results from a prospective multicenter German surveillance study.
BACKGROUND
Nosocomially acquired respiratory syncytial virus infections (RSV-NI) may cause serious problems in hospitalized paediatric patients. Hitherto, prospectively collected representative data on RSV-NI from multicenter studies in Germany are limited.


METHODS
The DMS RSV Ped database was designed for the prospective multicenter documentation and analysis of clinically relevant aspects of the management of inpatients with RSV-infection. The study covered six consecutive seasons (1999-2005); the surveillance took place in 14 paediatric hospitals in Germany.


RESULTS
Of the 1568 prospectively documented RSV-infections, 6% (n=90) were NI and 94% (n=1478) were community acquired (CA). A significantly higher proportion in the NI group displayed additional risk factors like prematurity, chronic lung disease, mechanical ventilation (med. history), congenital heart disease, and neuromuscular impairment. Of all NI, 55% occurred in preterms (30.6% of all RSV-infections in preterms with severe chronic lung disease of prematurity were NI). Illness severity as well as the total mortality, but not the attributable mortality was significantly higher in the NI group. In the multivariate analysis, NI was significantly associated with the combined outcome 'complicated course of disease'.


CONCLUSIONS
This is the first prospective multicenter study from Germany, which confirms the increased risk of a severe clinical course in nosocomially acquired RSV-infection. Of great concern is the high rate of (preventable) NI in preterms, in particular in those with severe chronic lung disease or with mechanical ventilation due to other reasons.
Simon
Arne
A
Department of Paediatric Hematology and Oncology, Children's Hospital Medical Center, University of Bonn, Adenauerallee119, 53113 Bonn, Germany. asimon@ukb.uni-bonn.de
Müller
Andreas
A
Khurana
Karun
K
Engelhart
Steffen
S
Exner
Martin
M
Schildgen
Oliver
O
Eis-Hübinger
Anna M
AM
Kamin
Wolfgang
W
Schaible
Thomas
T
Wadas
Karoline
K
Ammann
Roland A
RA
Wilkesmann
Anja
A
D017714:Community-Acquired Infections / Q000453:epidemiology / Q000821:virology; D003428:Cross Infection / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D016208:Databases, Factual; D005260:Female; D005858:Germany / Q000453:epidemiology; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D009305:Nasopharynx / Q000821:virology; D011159:Population Surveillance; D011446:Prospective Studies; D012044:Regression Analysis; D018357:Respiratory Syncytial Virus Infections / Q000150:complications / Q000453:epidemiology*; D012136:Respiratory Syncytial Viruses / Q000302:isolation & purification; D012307:Risk Factors; D012720:Severity of Illness Index