Nosocomial Gastroenteritis in Children With and Without Rotavirus Infection

Abstract

To the Editors: Rotavirus (RV) is the most common cause of severe gastroenteritis in children and the proportion of childhood gastroenteritis hospitalizations attributed to RV has recently increased from 22% to 39%.1 RV gastroenteritis is also one of the leading nosocomial infections in the pediatric age group.2 Although the typical symptoms in nosocomial RV gastroenteritis are well recognized,2 information regarding the differences of clinical presentation and evolution of nosocomial gastroenteritis with and without RV infection is scarce. We performed a retrospective cohort study on nosocomial infection in a pediatric university hospital in Salvador, Brazil, between October 2002 and September 2005. Nosocomial gastroenteritis was defined as >3 watery or looser-than-normal stools and/or a single episode of forceful vomiting within a 24-hour period after the first 72 hours of hospitalization. RV antigen was searched for in stool specimens by a rapid latex assay (ROTA Rich, Richmond Diagnostics, Spain). Data were collected from an epidemiologic surveillance form of the Nosocomial Infection Control Service and laboratory database; details regarding the child's illness were collected from the patient charts. All hospitalized patients were actively surveyed to detect occurrence of nosocomial infection. Fever was defined as axillary temperature >37.5°C. The study was approved by the Ethics Committee of the Federal University of Bahia. Overall, 125 cases of nosocomial gastroenteritis were identified, of which 66 had the rotavirus assay performed and the patient chart accessible for review. Therefore, the study group comprised 66 cases, of which 49 (74%) were RV positive. None of the patients had chronic gastrointestinal tract disease, immunodeficiency, or bacterial intestinal infection. The median age was 7 (mean, 11 ± 13; range, 0.3–105) months and there were 39 (59%) males. There was no difference in age (month) (10 ± 8 vs. 16 ± 27) or male gender (57% vs. 65%) distribution when patients with and without RV infection were compared, as well as in the length of signs and symptoms or duration of hospitalization (data not shown). Vomiting (69% vs. 41%, P = 0.04, OR 3.2, 95% CI 1.04–10.1), dehydration (37% vs. 6%, P = 0.02, OR 9.3, 95% CI 1.1–76), the combination of symptoms fever, vomiting, and diarrhea (49% vs. 18%, P = 0.02, OR 4.5, 95% CI 1.1–18) and fever, diarrhea, and dehydration (29% vs. 0%, P = 0.01, OR 1.5, 95% CI 1.2–1.8) were associated with RV infection. All patients were discharged from hospital after improvement. Vomiting and fever have been recognized as prominent symptoms in RV-associated hospitalized cases.3 Among community-acquired RV infected hospitalized children, the combination of fever, vomiting, and diarrhea was the most frequent clinical presentation (63%).4 We found similar features among our patients with nosocomial RV gastroenteritis. This finding may be explained by the nosocomial RV acquisition because of circulation of community-acquired RV in the hospital.3 Despite the association with dehydration, the length of hospitalization was not different between patients with and without RV because of early diagnosis and rapid rehydration. Licia L. Moreira, RN Infection Control Service of the Professor Hosannah de Oliveira Pediatric Center Federal University of Bahia Salvador, Brazil Eduardo M. Netto, MD, PhD Infectious Diseases Unit University Hospital Federal University of Bahia Salvador, Brazil Cristiana M. Nascimento-Carvalho, MD, PhD Department of Pediatrics School of Medicine Federal University of Bahia Salvador, Brazil