title: Nosocomial respiratory syncytial virus infections in the palivizumab-prophylaxis era with implications regarding high-risk infants.
abstract: BACKGROUND
  Although respiratory syncytial virus (RSV) infection continues to be a leading cause of infant hospitalization with a high transmission rate, recent data on nosocomial RSV infection are scarce. This study investigated the clinical and epidemiologic characteristics of nosocomial RSV infection in the palivizumab-prophylaxis era.
  
  
  METHODS
  The database of a tertiary pediatric medical center was searched for all hospitalized patients with RSV-positive respiratory disease in 2008-2010. Data were compared between patients with community-associated and nosocomial disease, and the qualification of the latter group for palivizumab was evaluated.
  
  
  RESULTS
  Of the 873 children identified, 30 (3.4%) had a nosocomial infection. This group accounted for 0.06% of all admissions during the study period. The nosocomial infection group had higher rates of preterm birth and severe underlying disease than the community-associated RSV group and a longer mean hospital stay. The nosocomial infection group also had higher rates of intensive care unit admission and mechanical ventilation. Although 73% had underlying conditions, most (80%) did not qualify for RSV immunoprophylaxis, including 7 children (23%) with immune deficiency.
  
  
  CONCLUSIONS
  Nosocomial RSV infection is a significant cause of morbidity among hospitalized infants, especially those with comorbidities and lengthy hospital stay, and is associated with a complicated clinical course. In addition to strict infection-control measures, extending palivizumab prophylaxis to additional selected high-risk populations should be considered.
authors.affiliation: Department of Pediatrics C, Schneider Children's Medical Center, Petach Tikva, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: ashkenazi.liat@gmail.com.
authors.forename: Liat
authors.initials: L
authors.lastname: Ashkenazi-Hoffnung
authors.affiliation: Department of Pediatrics C, Schneider Children's Medical Center, Petach Tikva, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Miri
authors.initials: M
authors.lastname: Dotan
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Pediatrics A, Schneider Children's Medical Center, Petach Tikva, Tel Aviv, Israel.
authors.forename: Gilat
authors.initials: G
authors.lastname: Livni
authors.affiliation: Department of Pediatrics C, Schneider Children's Medical Center, Petach Tikva, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Amir
authors.affiliation: Department of Pediatrics C, Schneider Children's Medical Center, Petach Tikva, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Efraim
authors.initials: E
authors.lastname: Bilavsky
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D003428:Cross Infection / Q000188:drug therapy* / Q000517:prevention & control*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D000069455:Palivizumab; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy* / Q000517:prevention & control*; D012141:Respiratory Tract Infections / Q000188:drug therapy*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents; D000069455:Palivizumab
keywords: Bronchiolitis; Health care–associated infections; Infants; Infection control; Palivizumab