Viral pathogens in children with bronchiolitis and the safety of room sharing.

Hoekstra, M.M. (2014) Viral pathogens in children with bronchiolitis and the safety of room sharing. thesis, Medicine.

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Abstract

Background: Bronchiolitis is an important cause of hospitalization during the winter in children under two years of age. Respiratory syncytial virus is the most common viral pathogen, although due to development of sensitive diagnostic methods, the number of detected viral pathogens in bronchiolitis has increased. Cohorting RSV-positive children separately from RSV-negative children, is a commonly applied procedure to prevent cross-infections in infants hospitalized for bronchiolitis. However, evidence for this procedure is lacking and clinical relevance of dual infections is unsure. Previous research in this hospital (Isala, Zwolle, The Netherlands) showed that sharing a room during first day of admission was safe. Objective: To determine the incidence and clinical severity of cross- infections in patients admitted with bronchiolitis, when patients with different causative viral agents share a room during the entire admission course. Methods: Prospective observational cohort study. In winter seasons 2012-2013 and 2013-2014 all infants under 2 years of age hospitalized for bronchiolitis, shared a bedroom during entire admission. Standard contact hygienic measures were applied in all patients (gowns, gloves and hand-washing) and beds are separated at least 1,5 meter. Nasopharyngeal aspirates were collected at admission, and every fourth day of stay, at discharge and 4-7 days after discharge for RT-PCR (Taqman® Fast Virus 1-step Mastermix, 15 viruses). In parents and visitors we collected throat swabs during admission for viral testing. Daily a clinical researcher assessed clinical information and dyspnoea scores. Nobody was aware of virological diagnosis because all specimens were tested batch wise on the end of the season. Results: From December 2012 until April 2014, 162 children were hospitalized for bronchiolitis. 113 Children were included. 100 Patients (88,5%) had RSV; 23 children (20,4%) were already co-infected before hospital admission. 100 Children (88,5%) shared a room; 47 (41,6%) of whom shared a room with a patient infected with a different virus. In twenty infants (17,7%) cross-infections occurred during admission. In a majority we could not found a source of the cross-infections. In four patients the second virus was identified in one of the roommates and in three cases the acquired virus was detected in relatives or visitors. Five cross-infections occurred with rhinovirus, in one adenovirus and in one rhino- and parechovirus. None of the RSV negative children became RSV positive. We found no significant differences in disease severity between mono or co-infected patients (length of hospital stay, IC admission, mechanical ventilation, oxygen supplementation and dyspnoea scores) Conclusion: Cross-infections among patients who share a room occur, but infections through roommates are rare. Co-infection does not seem to have clinically more severe disease. Conclusively, sharing a room independent of viral etiology in children with bronchiolitis is safe. The results suggest that routinely performing virological tests for the purpose of cohorting may not be necessary.

Item Type:	Thesis (Thesis)
Supervisor name:	Bekhof, Dr. J. and Isala, Amalia kindercentrum and Zwolle
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:52
Last Modified:	25 Jun 2020 10:52
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1349

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