The Impact of Multiple Viral Infection in Children with Severe Lower Respiratory Tract Infections

INTRODUCTION: We aimed to compare the clinical features and outcomes between single and multiple viral pathogens in children with severe lower respiratory tract infections (LRTIs) in pediatric intensive care unit (PICU).
METHODS: This study was conducted retrospectively in patients who were admitted to PICU between March 2018 and March 2020. All the subjects were divided into two groups. Epidemiologic characteristics, clinical features, disease severity and outcomes compared between single and multiple viral infection groups.
RESULTS: During the study period, positive polymerase chain reaction (PCR) test was revealed in 136 (29%) children among 468 children admitted PICU with the diagnosis of LRTI. Rhinovirus and Respiratory Syncytial Virus (RSV) were the most commonly identified virus (respectively 44.1% and 35.2%). Thirty nine (28,6%) of samples were detected two viruses in PCR tests. Rhinovirus and RSV coinfection was the most common combination (10/39, 25.6%) in our cohort. Multiple viral infection group had higher Pediatric Risk of Mortality Score (PRISM) scores than single virus infection group (10 vs 7, respectively, p=0.009). In multiple viral infection group invasive ventilatory support rate (56.4% vs 36.1%, p=0.030) and noninvasive ventilatory support rate (43.5% vs 6.1%, p=0.018) were significantly higher than in single viral infection group.

DISCUSSION AND CONCLUSION: Lower respiratory multiviral infections are associated with increased invasive and noninvasive ventilatory support requirements. Close monitoring in a unit where these supports can be provided is essential for infants with multiviral LRTIs.