Burden of Disease in Hospitalized RSV-positive Children in Germany

Abstract

Background: In spite of a large amount of data from other countries, those on the burden of disease attributed to respiratory syncytial virus (RSV) in Germany are lacking and are urgently needed. Method: In a population-based cross-sectional study from July 1996 to June 1999 150 children from birth to 16 years of age hospitalized in Kiel and tested positive for RSV by polymerase chain reaction were investigated. Stepwise linear and logistic regression models were applied to predict a bacterial co-infection as well as the duration of hospitalization. Results: Pneumonia (54 %) and wheezing bronchitis (including bronchiolitis, 27 %) were the predominating diagnoses; 25 % had an underlying condition. Four patients needed nasal continuous airway pressure and one intermittent mandatory ventilation; none died. According to the surrogate markers CRP and immature neutrophil fraction, 20 % to 30 % were suspected to have a bacterial co-infection on admission; antibiotics were prescribed in 65 % of the patients. The average duration of hospitalization was 9 days and was best predicted by young age, the presence of an underlying condition, intercostal retractions and high CRP on admission. Conclusions: Bacterial co-infection is the major confounder in burden of disease analyses in RSV. The decision not to administer antibiotics to children hospitalized with RSV can be risky, particularly when there is considerable diagnostic uncertainty. Within the realm of current clinical practice, complications and deaths related to RSV are rare in Germany.

Zusammenfassung

Hintergrund: Trotz einer großen Datenmenge zur klinischen Bedeutung der RSV-Infektion in anderen Ländern ist diesbezüglich die Datenlage in Deutschland noch unzureichend. Methode: In einer populationsbezogenen Querschnittsstudie von Juli 1996 bis Juni 1999 wurden 150 Kinder im Alter von 0 - 16 Jahren eingeschlossen, die in Kiel stationär behandelt wurden und mittels Polymerase-Ketten-Reaktion positiv für RSV getestet wurden. Schrittweise lineare und logistische Regressionsmodelle wurden verwendet, um eine bakterielle Koinfektion vorherzusagen und die Einflussgrößen auf die stationäre Behandlungsdauer erkennen zu können. Ergebnisse: Pneumonien (54 %) und obstruktive Bronchitiden (einschließlich Bronchiolitis, 27 %) waren die häufigsten Diagnosen; 25 % der Patienten hatten eine chronische Grundkrankheit. Vier bedurften einer nasalen CPAP- und ein Patient einer IMV-Beatmung; kein Patient verstarb. Entsprechend den Surrogatmarker C-reaktives Protein und unreife neutrophile Granulozyten hätten 20 - 30 % eine bakterielle Koinfektion zum Zeitpunkt der stationären Aufnahme gehabt; 65 % erhielten Antibiotika. Die durchschnittliche stationäre Behandlungsdauer betrug 9 Tage und wurde am stärksten durch das junge Alter des Patienten, dem Vorhandensein einer Grundkrankheit, interkostalen Einziehungen und einem hohen C-reaktiven Protein erklärt. Schlussfolgerungen: Bakterielle Koinfektionen sind die wichtigste Verzerrvariable bei der Analyse der Bedeutung von RSV-Infektionen. Die Entscheidung stationär wegen RSV zu behandelnden Kindern kein Antibiotikum zu geben, kann gefährlich sein, insbesondere in Anbetracht der diagnostischen Unsicherheit für bakterielle tiefe Atemwegsinfektionen bei Kindern. Beim derzeitigen klinischen Vorgehen sind Komplikationen und Todesfälle in Verbindung mit einer RSV-Infektion in Deutschland selten.

Acute respiratory tract infection - C-reactive protein - Disease burden - Infiltrates - RSV

Akute Atemwegsinfektion - C-reaktives Protein - Infiltrate - RSV - Stationär

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