Infection Preventionist Vail Health Vail, Colorado, United States
Disclosure(s):
Caitlyn Ngam, MPH, CIC, CPHQ: No financial relationships to disclose
Background: During the fall and winter of 2022, there was an increase of pediatric patients presenting to the emergency department (ED) due to Respiratory Syncytial Virus (RSV), COVID-19, and influenza in addition to other respiratory viruses. Previous studies show an association between multiple viral agents and an increased risk of severe disease and hospitalization for pediatric patients. Isolation recommendations vary based on the type of pathogen, and isolation may be inappropriate in the presence of multiple pathogens with differing recommendations
Methods: A retrospective review was performed that included all pediatric patients (aged < 12) presenting to the ED in a 56-bed community hospital who were tested using a respiratory pathogen polymerase chain reaction panel between October and mid-December 2022. Pediatric patients with respiratory symptoms were tested using this assay in this setting. Test results, discharge status, and isolation recommendations based on viral pathogens were collected.
Results: Among our study population (n=85), 71% (n=60) tested positive for one pathogen whereas 29% (n=25) tested positive for >1 pathogen. Children who tested positive for >1 pathogen (32%, n=8) were significantly more likely to be admitted or transferred to a higher level of care than children who tested positive for only one pathogen (12%, n=7, p=0.03). Of the patients that tested positive for >1 pathogen, 84% (n=21) had an indication for more than one type of isolation based on CDC recommendations.
Conclusions: Traditionally, respiratory panels aren’t used exclusively on outpatients due to expense. Many pediatric patients who are admitted are tested specifically for RSV, flu, and COVID-19. This unique study provided a glimpse into the more critical pediatric population and highlighted two key points: (1) over half of the admitted pediatric population was carrying >1 pathogen and (2) the need for contact/droplet isolation to protect staff and other patients from multiple pathogens that may go unidentified is imperative.
Learning Objectives:
Describe the likelihood of infection with multiple viral pathogens among pediatric patients.
Describe how infection with multiple viral pathogens impacts isolation recommendations.
Analyze epidemiological trends in order to establish empiric isolation recommendations.
