title: Detection of Multiple Respiratory Viruses Associated With Mortality and Severity of Illness in Children.
abstract: OBJECTIVE
  Respiratory viral infection is a common source of morbidity and mortality in children. Coinfection with multiple viruses occurs frequently; however, the clinical significance of concomitant viral pathogens is unclear. We hypothesized that presence of more than one respiratory virus is associated with increased morbidity and mortality when compared with children with a single respiratory virus.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A tertiary care hospital.
  
  
  METHODS
  All children at Duke Children's Hospital over a 2-year period with isolation of a virus on an extended viral respiratory panel result. Demographic data, comorbidities, and details of hospital encounter were recorded.
  
  
  METHODS
  None.
  
  
  RESULTS
  Two hundred thirty-five hospital encounters demonstrated positive extended viral respiratory panels. Immunocompromised status (37%) and respiratory comorbidities (23%) were common. Twenty-eight patients (12%) tested positive for multiple viruses, with adenovirus (23/28) and respiratory syncytial virus (15/28) most prevalent in patients with multiple viruses. Viral codetection was associated with increased use of noninvasive ventilation (p = 0.02), extracorporeal membrane oxygenation (p = 0.02), increased likelihood of moderate or severe illness (p = 0.005), and increased mortality (p = 0.01). Subgroup analysis demonstrated that this mortality association persisted for children with normal immune function (p = 0.003) and children with no comorbidities (p = 0.007).
  
  
  CONCLUSIONS
  Children with multiple respiratory viruses may be at increased risk of moderate or severe illness and mortality, with previously healthy children potentially being at greatest risk. Further studies are indicated to determine the significance and generalizability of this finding and to better understand the pathophysiology of viral coinfection.
authors.affiliation: 1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, NC. 2Division of Critical Care, Children's National Medical Center, Washington, DC. 3Division of Infectious Diseases, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, NC.
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Rehder
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Wilson
authors.forename: Kanecia O
authors.initials: KO
authors.lastname: Zimmerman
authors.forename: Coleen K
authors.initials: CK
authors.lastname: Cunningham
authors.forename: David A
authors.initials: DA
authors.lastname: Turner
mesh_terms: D000258:Adenovirus Infections, Human / Q000401:mortality* / Q000821:virology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D018184:Paramyxoviridae Infections / Q000401:mortality* / Q000821:virology; D018357:Respiratory Syncytial Virus Infections / Q000401:mortality* / Q000821:virology; D012141:Respiratory Tract Infections / Q000401:mortality* / Q000821:virology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D062606:Tertiary Care Centers