Nosocomial Infections in Patients Hospitalized with Respiratory Syncytial Virus: A Practice Review

  • August Wrotek
  • Małgorzata Czajkowska
  • Teresa JackowskaEmail author
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1271)


Viral testing is not always recommended in children with bronchiolitis due to doubts concerning its prognostic use. In this retrospective study, we investigated how the RSV testing would influence the frequency of nosocomial infections (NI). The files of 305 children, hospitalized due to the respiratory syncytial virus (RSV) infection in the period 2010–2014, were reviewed in the study. We found ten cases of NI. The RSV preventive measures did not vary in the consecutive years investigated, but the number of viral tests substantially varied. In 2010, 2012, and 2014, when ca. 2 tests per RSV(+) patient were performed, the risk of NI per patient was 1.3%, while in 2011 and 2013, when the RSV testing was less frequent, the accumulated risk per patient was 5.2%. There was a strong adverse relationship between the number of tests performed and the number of NI (rho = −0.975). The children with NI, when compared to those without NI, required a longer hospital stay, generating higher hospital costs regarding treatment, productivity loss, and indirect costs. The expenditure for RSV testing in the years of a low NI risk was higher than that in the high-risk years. Conversely, the expenditure related to NI management was lower in the years of a low NI risk. Each euro spent on RSV testing saved over 26 € from the NI management expenditure. We conclude that RSV testing is needed in the hospital setting to isolate the infected children and to prevent nosocomial RSV spread. This strategy is health advantageous and requires less resources than NI treatment.


Bronchiolitis Community-acquired disease Health costs Healthcare Nosocomial infection Respiratory syncytial virus Treatment efficacy 



This study was supported by CMKP Grant 501-1-020-19-19.

Conflicts of Interest

The authors declare no conflict of interest in relation to this article.

Ethical Approval

This retrospective review of medical files does not contain any experiments with human participants or animals performed by any of the authors.

Informed Consent

There are no identifiable participants included in this retrospective article. Therefore, there was no requirement to obtain individual informed consent.


  1. AAP, American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis (2006) Diagnosis and management of bronchiolitis. Pediatrics 118:1774–1793CrossRefGoogle Scholar
  2. Ampofo K, Bender J, Sheng X, Korgenski K, Daly J, Pavia AT, Byington CL (2008) Seasonal invasive pneumococcal disease in children: role of preceding respiratory viral infection. Pediatrics 122:229–237CrossRefGoogle Scholar
  3. Dadlez NM, Esteban-Cruciani N, Khan A, Douglas LC, Shi Y, Southern WN (2017) Risk factors for respiratory decompensation among healthy infants with bronchiolitis. Hosp Pediatr 7:530–535CrossRefGoogle Scholar
  4. GBD 2015 LRI Collaborators (2017) Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis 17:1133–1161CrossRefGoogle Scholar
  5. Hall CB, Douglas RG Jr, Geiman JM, Messner MK (1975) Nosocomial respiratory syncytial virus infections. N Engl J Med 293:1343–1346CrossRefGoogle Scholar
  6. Hall CB, Douglas RG Jr, Geiman JM (1980) Possible transmission by fomites of respiratory syncytial virus. J Infect Dis 141:98–102CrossRefGoogle Scholar
  7. Hall CB, Weinberg GA, Blumkin AK, Edwards KM, Staat MA, Schultz AF, Poehling KA, Szilagyi PG, Griffin MR, Williams JV, Zhu Y, Grijalva CG, Prill MM, Iwane MK (2013) Respiratory syncytial virus-associated hospitalizations among children less than 24 months of age. Pediatrics 132:e341–e348CrossRefGoogle Scholar
  8. Hament JM, Aerts PC, Fleer A, Van Dijk H, Harmsen T, Kimpen JL, Wolfs TF (2004) Enhanced adherence of Streptococcus pneumoniae to human epithelial cells infected with respiratory syncytial virus. Pediatr Res 55:972–978CrossRefGoogle Scholar
  9. Karanfil LV, Conlon M, Lykens K, Masters CF, Forman M, Griffith ME, Townsend TR, Perl TM (1999) Reducing the rate of nosocomially transmitted respiratory syncytial virus. Am J Infect Control 27:91–96CrossRefGoogle Scholar
  10. Leclair JM, Freeman J, Sullivan BF, Crowley CM, Goldmann DA (1987) Prevention of nosocomial respiratory syncytial virus infections through compliance with glove and gown isolation precautions. N Engl J Med 317:329–334CrossRefGoogle Scholar
  11. Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, Rudan I, Campbell H, Cibulskis R, Li M, Mathers C, Black RE, Child Health Epidemiology Reference Group of WHO and UNICEF (2012) Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 379:2151–2161CrossRefGoogle Scholar
  12. Macartney KK, Gorelick MH, Manning ML, Hodinka RL, Bell LM (2000) Nosocomial respiratory syncytial virus infections: the cost-effectiveness and cost-benefit of infection control. Pediatrics 106:520–526CrossRefGoogle Scholar
  13. Madhi SA, Klugman KP, Vaccine Trialist Group (2004) A role for Streptococcus pneumoniae in virus-associated pneumonia. Nat Med 10:811–813CrossRefGoogle Scholar
  14. Mansbach JM, McAdam AJ, Clark S, Hain PD, Flood RG, Acholonu U, Camargo CA Jr (2008) Prospective multicenter study of the viral etiology of bronchiolitis in the emergency department. Acad Emerg Med 15:111–118CrossRefGoogle Scholar
  15. Mansbach JM, Piedra PA, Teach SJ, Sullivan AF, Forgey T, Clark S, Espinola JA, Camargo CA Jr, MARC-30 Investigators (2012) Prospective multicenter study of viral etiology and hospital length of stay in children with severe bronchiolitis. Arch Pediatr Adolesc Med 166:700–706CrossRefGoogle Scholar
  16. McGillivary G, Mason KM, Jurcisek JA, Peeples ME, Bakaletz LO (2009) Respiratory syncytial virus-induced dysregulation of expression of a mucosal beta-defensin augments colonization of the upper airway by non-typeable Haemophilus influenzae. Cell Microbiol 11:1399–1408CrossRefGoogle Scholar
  17. Mesquita FDS, Oliveira DBL, Crema D, Pinez CMN, Colmanetti TC, Thomazelli LM, Gilio AE, Vieira SE, Martinez MB, Botosso VF, Durigon EL (2017) Rapid antigen detection test for respiratory syncytial virus diagnosis as a diagnostic tool. J Pediatr 93:246–252CrossRefGoogle Scholar
  18. Mills JM, Harper J, Broomfield D, Templeton KE (2011) Rapid testing for respiratory syncytial virus in a paediatric emergency department: benefits for infection control and bed management. J Hosp Infect 77:248–251CrossRefGoogle Scholar
  19. Murphy TF, Bakaletz LO, Smeesters PR (2009) Microbial interactions in the respiratory tract. Pediatr Infect Dis J 28:S121–S126CrossRefGoogle Scholar
  20. Nair H, Nokes DJ, Gessner BD, Dherani M, Madhi SA, Singleton RJ, O’Brien KL, Roca A, Wright PF, Bruce N, Chandran A, Theodoratou E, Sutanto A, Sedyaningsih ER, Ngama M, Munywoki PK, Kartasasmita C, Simões EA, Rudan I, Weber MW, Campbell H (2010) Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet 375:1545–1555CrossRefGoogle Scholar
  21. Peters RM, Schnee SV, Tabatabai J, Schnitzler P, Pfeil J (2017) Evaluation of Alere I RSV for rapid detection of respiratory syncytial virus in children hospitalized with acute respiratory tract infection. J Clin Microbiol 55:1032–1036CrossRefGoogle Scholar
  22. Prendergast C, Papenburg J (2013) Rapid antigen-based testing for respiratory syncytial virus: moving diagnostics from bench to bedside? Future Microbiol 8(4):435–444CrossRefGoogle Scholar
  23. Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM, Johnson DW, Light MJ, Maraqa NF, Mendonca EA, Phelan KJ, Zorc JJ, Stanko-Lopp D, Brown MA, Nathanson I, Rosenblum E, Sayles S 3rd, Hernandez-Cancio S, American Academy of Pediatrics (2014) Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics 134:e1474–e1502CrossRefGoogle Scholar
  24. Stollar F, Alcoba G, Gervaix A, Argiroffo CB (2014) Virologic testing in bronchiolitis: does it change management decisions and predict outcomes? Eur J Pediatr 173:1429–1435CrossRefGoogle Scholar
  25. Suárez-Arrabal MC, Mella C, Lopez SM, Brown NV, Hall MW, Hammond S, Shiels W, Groner J, Marcon M, Ramilo O, Mejias A (2015) Nasopharyngeal bacterial burden and antibiotics: influence on inflammatory markers and disease severity in infants with respiratory syncytial virus bronchiolitis. J Infect 71:458–469CrossRefGoogle Scholar
  26. Talbot TR, Poehling KA, Hartert TV, Arbogast PG, Halasa NB, Edwards KM, Schaffner W, Craig AS, Griffin MR (2005) Seasonality of invasive pneumococcal disease: temporal relation to documented influenza and respiratory syncytial virus circulation. Am J Med 118:285–291CrossRefGoogle Scholar
  27. Techasaensiri B, Techasaensiri C, Mejías A, McCracken GH Jr, Ramilo O (2010) Viral coinfections in children with invasive pneumococcal disease. Pediatr Infect Dis J 29:519–523PubMedGoogle Scholar
  28. Weinberger DM, Givon-Lavi N, Shemer-Avni Y, Bar-Ziv J, Alonso WJ, Greenberg D, Dagan R (2013) Influence of pneumococcal vaccines and respiratory syncytial virus on alveolar pneumonia, Israel. Emerg Infect Dis 19:1084–1091CrossRefGoogle Scholar
  29. Weinberger DM, Klugman KP, Steiner CA, Simonsen L, Viboud C (2015) Association between respiratory syncytial virus activity and pneumococcal disease in infants: a time series analysis of US hospitalization data. PLoS Med 12:e1001776CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • August Wrotek
    • 1
    • 2
  • Małgorzata Czajkowska
    • 1
    • 2
  • Teresa Jackowska
    • 1
    • 2
    Email author
  1. 1.Department of PediatricsCenter of Postgraduate Medical EducationWarsawPoland
  2. 2.Department of PediatricsBielanski HospitalWarsawPoland

Personalised recommendations