From the *Department of Paediatrics, Division of Infectious Diseases, The Hospital for Sick Children, University of Toronto; †Research Institute, The Hospital for Sick Children, University of Toronto; ‡Department of Paediatric Laboratory Medicine, Division of Microbiology, The Hospital for Sick Children; §Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto; and ¶Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada.
Pediatr Infect Dis J. 2013 Oct;32(10):1073-6. doi: 10.1097/INF.0b013e31829dff4d.
Respiratory syncytial virus (RSV) is associated with significant morbidity and mortality in immunocompromised children. Data on the risk factors for acquisition and outcomes from RSV infections in this population are limited.
This cohort study (2006 to 2011) included RSV-positive immunocompromised pediatric inpatients. Nasopharyngeal swabs were tested for RSV by direct immunofluorescence. Purposeful multiple regression was used to assess risk factors associated with community-acquired RSV (CA-RSV) infections and their outcomes compared with nosocomial (N-RSV) infections. Means and medians were compared using Student's t test and a nonparametric test, respectively. Proportions were compared using χ(2) or Fisher's exact test, as appropriate.
There were 117 RSV-positive patients of whom 42 (35.9%) presented with (N-RSV) infection. Overall, more than a third presented with lower respiratory tract infections, which resulted in a 28% admission rate to the intensive care unit and a mortality rate of 5%; the latter solely among patients with community-acquired infection. Subjects with CA-RSV presented with more advanced clinical evidence of lower tract disease with respiratory distress (eg, intercostal recession; odds ratio 2.5; 95% confidence interval: 1.1-5.6; P = 0.03) compared with those with N-RSV. Subjects with CA-RSV infections were less likely to have a prolonged hospital admission (odds ratio 0.7; 95% confidence interval: 0.5-0.8; P < 0.0001) relative to those with N-RSV infections.
RSV-related infections in immunocompromised children may result in poor outcomes, including mortality. Differences in mortality rates among those with CA-RSV compared with N-RSV warrant further study, with enhanced opportunities for prevention and early detection of infection.
呼吸道合胞病毒（RSV）可导致免疫功能低下的儿童出现严重的发病率和死亡率。关于该人群中 RSV 感染的危险因素和结局的数据有限。
这项队列研究（2006 年至 2011 年）纳入了 RSV 阳性的免疫功能低下的儿科住院患者。通过直接免疫荧光法检测鼻咽拭子中 RSV 的存在。采用有目的的多元回归分析来评估与社区获得性 RSV（CA-RSV）感染相关的危险因素，并将其与医院获得性（N-RSV）感染的结局进行比较。使用 Student's t 检验和非参数检验分别比较均值和中位数。使用 χ(2)检验或 Fisher 确切概率法比较比例，具体情况视需要而定。
共纳入 117 例 RSV 阳性患者，其中 42 例（35.9%）为 N-RSV 感染。总体而言，超过三分之一的患者表现为下呼吸道感染，导致 28%的患者需要入住重症监护病房，死亡率为 5%；而这一死亡率仅见于社区获得性感染患者。与 N-RSV 相比，CA-RSV 患者的下呼吸道疾病的临床表现更为严重，存在呼吸窘迫的表现（如肋间隙凹陷）（比值比 2.5；95%置信区间：1.1-5.6；P = 0.03）。与 N-RSV 患者相比，CA-RSV 感染患者的住院时间延长的可能性更小（比值比 0.7；95%置信区间：0.5-0.8；P < 0.0001）。
免疫功能低下的儿童感染 RSV 可能导致严重的后果，包括死亡。CA-RSV 患者与 N-RSV 患者相比，死亡率存在差异，这需要进一步研究，为感染的预防和早期发现提供更好的机会。
