title: Risk factors and outcomes for respiratory syncytial virus-related infections in immunocompromised children.
abstract: 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 χ(2) 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.
authors.affiliation: 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.
authors.forename: Sandra
authors.initials: S
authors.lastname: Asner
authors.forename: Derek
authors.initials: D
authors.lastname: Stephens
authors.forename: Paul
authors.initials: P
authors.lastname: Pedulla
authors.forename: Susan E
authors.initials: SE
authors.lastname: Richardson
authors.forename: Joan
authors.initials: J
authors.lastname: Robinson
authors.forename: Upton
authors.initials: U
authors.lastname: Allen
mesh_terms: D000704:Analysis of Variance; D002675:Child, Preschool; D015331:Cohort Studies; D003428:Cross Infection / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D007902:Length of Stay; D008297:Male; D018357:Respiratory Syncytial Virus Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000276:immunology; D012307:Risk Factors; D016896:Treatment Outcome