title: An investigation into the prevalence and outcome of patients admitted to a pediatric intensive care unit with viral respiratory tract infections in Cape Town, South Africa.
abstract: OBJECTIVE
  To describe the prevalence and outcome of patients admitted to a pediatric intensive care unit with viral respiratory tract infections.
  
  
  METHODS
  Retrospective descriptive study.
  
  
  METHODS
  Pediatric intensive care unit in a tertiary pediatric hospital situated in Cape Town, South Africa.
  
  
  METHODS
  All children (n = 195; 20% pediatric intensive care unit admissions) with positive respiratory viral isolates between April 1 and December 31, 2009.
  
  
  METHODS
  None.
  
  
  RESULTS
  Demographic, clinical, laboratory, and outcome data were recorded from medical folders. Complete data were available for 175 patients (median age [interquartile range] 4.7 months [2.3-12.9 months]; 49% male). One hundred four (59.4%) patients had comorbid conditions; 30 (17%) were HIV-infected. Rhinovirus (n = 76 [39%]), respiratory syncytial virus (n = 54 [27.7%]), adenovirus (n = 30 [15.4%]), influenza A (n = 26 [13.3%]), parainfluenza (n = 23 [11.8%]), and human metapneumovirus (n = 12 [6.2%]) were most commonly isolated. Ninety-five infections (51.4%) were isolated >48 hrs after admission. Seasonal patterns were identified for respiratory syncytial virus, human metapneumovirus, and influenza A, whereas others occurred throughout the year. Twenty-five patients (14.3%) had more than one viral isolate. Presumed bacterial coinfection, which occurred in 68 (39%) patients (18 [26.5%] HIV-infected), was associated with significantly longer pediatric intensive care unit and hospital stays but not with mortality. Twenty patients died (11%, standardized mortality ratio 0.64). High Pediatric Index of Mortality scores, HIV exposure and infection, nosocomial infection, and influenza A infection were associated with mortality.
  
  
  CONCLUSIONS
  Viral respiratory tract infection is common in this pediatric intensive care unit associated with significant morbidity and mortality, which may relate to the high burden of comorbidity and HIV.
authors.affiliation: Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
authors.forename: Ani S Abdul
authors.initials: AS
authors.lastname: Ghani
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Morrow
authors.forename: Diana R
authors.initials: DR
authors.lastname: Hardie
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Argent
mesh_terms: D000258:Adenovirus Infections, Human / Q000453:epidemiology; D001424:Bacterial Infections / Q000453:epidemiology; D060085:Coinfection / Q000453:epidemiology* / Q000401:mortality; D016001:Confidence Intervals; D003428:Cross Infection / Q000401:mortality*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D007223:Infant; D009980:Influenza A virus; D007251:Influenza, Human / Q000401:mortality / Q000821:virology; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D029121:Metapneumovirus; D016017:Odds Ratio; D018184:Paramyxoviridae Infections / Q000453:epidemiology / Q000821:virology; D010850:Picornaviridae Infections / Q000453:epidemiology; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000401:mortality / Q000821:virology*; D012189:Retrospective Studies; D012621:Seasons; D013019:South Africa / Q000453:epidemiology