Does the Presence of Multiple Respiratory Pathogens Indicate more Severe Illness in Hospitalized Children?

Abstract

Background: There is new information regarding respiratory infection etiologies in Pediatrics. With the ability to test for 20 pathogens with a single nasal swab, we aimed to: 1. Study the relevance of respiratory pathogen testing in the con-text of hospitalized children and the incidence of multiple pathogens or "co-infection." 2. Determine whether patients with multiple pathogens have a longer length of stay (LOS) than those children with a single pathogen. 3. Determine whether children with multiple pathogens have more severe illness—as indicated by oxygen use, antibiotic use, or requirement of critical care—compared to those chil-dren with one pathogen identified. Methods: Electronic medical records of patients who had respiratory pathogen panel (RPP) polymerase chain reaction (PCR) testing during the winter of 2011-2012 at a tertiary care chil-dren’s hospital were reviewed. RPP results, LOS, oxygen use, antibiotic use, and critical care interven-tions were noted. Data were analyzed with Pearson chi-square and Cox proportional hazard regression. Results: 93 RPPs (83%) tested positive for a single pathogen, and 19 RPPs (17%) were positive for multiple pathogens. Patients with co-infections had more severe disease as defined by the requirement of intensive care (p=0.02, OR 3.51, 1.2-9.8). There was no significant difference in oxygen use or antibiotic use between patients with one or more than one pathogen. The co-infection group was hospitalized for a median of 67 hours versus 41 hours for the single pathogen group (p= 0.01). This increased hospital LOS for the co-infection group was also seen in Cox regression analysis (p=0.007). Conclusions: Hospitalized children with multiple pathogens on RPP testing have statistically longer LOS and more severe illness. Keywords: Bronchiolitis, respiratory pathogen panel, co-infection, antibiotic, polymerase chain reaction.