title: Hospital-acquired viral infection increases mortality in children with severe viral respiratory infection.
abstract: OBJECTIVE
  To investigate the association of method of acquisition (hospital-acquired vs. community-acquired) and mortality in children with severe viral respiratory infection.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  : Pediatric intensive care unit at an urban academic tertiary care children's hospital.
  
  
  METHODS
  All patients aged <18 yrs admitted to our pediatric intensive care unit with laboratory-confirmed respiratory syncytial virus, influenza, parainfluenza, or adenovirus infection between October 2002 and September 2008.
  
  
  METHODS
  We stratified patients by method of viral acquisition and identified those patients with chronic medical conditions associated with an increased risk of complications from viral illness.
  
  
  RESULTS
  There were 289 patients admitted to the pediatric intensive care unit with laboratory-confirmed viral respiratory infection during the period of study. Fifty-three patients (18%) had hospital-acquired infection and 117 patients (40%) had chronic medical conditions associated with an increased risk of complications from viral illness. Hospital-acquired infection was associated with increased mortality and length of stay (all p < .001). Adjusting for age, chronic medical conditions, severity of illness index, and catheter-associated bloodstream infections, patients with hospital-acquired infection had a 5.8 (95% confidence interval 2.1-15.6) times greater odds (p = .001) of mortality.
  
  
  CONCLUSIONS
  Our results suggest that in children with severe viral respiratory infection, hospital acquisition of infection is associated with increased mortality even after adjusting for chronic medical conditions that predispose to an increased risk of complications from viral illness.
authors.affiliation: Children's National Medical Center, Washington, DC, USA. mspaeder@childrensnational.org
authors.forename: Michael C
authors.initials: MC
authors.lastname: Spaeder
authors.forename: James C
authors.initials: JC
authors.lastname: Fackler
mesh_terms: D002675:Child, Preschool; D003428:Cross Infection / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D008485:Medical Audit; D012141:Respiratory Tract Infections / Q000401:mortality / Q000503:physiopathology* / Q000821:virology*; D012189:Retrospective Studies; D012720:Severity of Illness Index