VCOM Carolinas Research Day 2023

Clinical Studies

The Incidence of Respiratory Syncytial Virus (RSV) Bronchiolitis and Concomitant Urinary Tract Infection (UTI) in Young Infants Samantha Houston, OMS III 1 ; Luke Saunders, OMS IV 1 ; Wesley Gregory, OMS IV 1 ; David Redden PhD 1 ;

Abstract # CLIN-16

Sami E. Rishmawi, MD 1,2 ; Hanna S. Sahhar, MD, FAAP, FACOP 1,2 1 Edward Via College of Osteopathic Medicine (VCOM), Spartanburg, SC 2 Spartanburg Regional Healthcare System (SRHS), Spartanburg, SC

Results (cont.)

Abstract

Results

● Only 3 (2 male, 1 female) of the 166 children had a positive urinalysis for a co-existing urinary tract infection.

Methods RSV is the leading cause of bronchiolitis leading to hospital admission among infants, while adjuvant bacterial infections pose a major risk for increased morbidity and mortality. Previous studies have attempted to establish a relationship between RSV infection and UTIs but have lacked robust evidence and yielded conflicting results. This study aims to further clarify a relationship between RSV and UTIs in order to aid the clinical decision-making process and determine the need for early intervention in this patient population. ❖ 269 pediatric patients diagnosed and admitted for bronchiolitis caused by RSV with 166 infants younger than 1 year of age ❖ Single-site, retrospective, observational study ❖ Spartanburg Regional Hospital PICU and General Pediatrics Ward from October 1 st , 2016, to December 16 th , 2021 ❖ Inclusion criteria: all patients less than 1 year of age admitted with a diagnosis of RSV during the defined study period ❖ Exact Chi Squared and Wilcoxon Rank Sum tests compared the incidence of co-infection and associated risk factors

● Using an exact 95% Confidence Interval, we estimate the true percent of children with co-infection to be between 0.37% and 5.19%.

Table 1. Patient Demographics

Conclusion

Figure 2. The forest plot displays the 90% Confidence Intervals for the Odds Ratio. A reference line for Odds Ratio equal to 1 is included. Perihilar infiltrates (p = 0.058) achieved significance at a = 0.1 while all other variables failed to achieve significance. The extreme width of the intervals is due to the small number of UTI events observed.

▪ No clinically significant rate of concomitant UTI in infants diagnosed with RSV bronchiolitis. ▪ Recommend against routinely obtaining urine studies in all patients less than 1 year old. ▪ Recommend workup for RSV-positive infants remain individualized and UTI diagnosis be pursued when there is high clinical suspicion for coinfection.

References

1. - Hall CB, Weinberg GA, Iwane MK, et al. The burden of respiratory syncytial virus infection in young children. N Engl J Med . 2009;360(6):588-598. doi: 10.1056/NEJMoa0804877

2. - Hendaus MA. Why Are Children With Bronchiolitis At Risk Of Urinary Tract Infections? Risk Manag Healthc Policy. 2019 Nov 14;12:251-254. doi: 10.2147/RMHP.S222470. PMID: 31819685; PMCID: PMC6881700. 3. - Zorc JJ, Levine DA, Platt SL, et al. Multicenter RSV-SBI Study Group of the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics; Clinical and Demographic Factors Associated With Urinary Tract Infection in Young Febrile Infants. Pediatrics 2005;116(3):644 – 648. doi: 10.1542/peds.2004-1825

Figure 1. Patient flow . Additional factors collected include exposure risk, month of exposure, prior medical history (congenital anomalies), admission location, length of stay, clinical presentation, clinical management, and complications during hospital stay.

Acknowledgements

Figure 3. Group Distribution. The graph displays means ± standard deviations for each outcome by UTI status in days. Due to the small number of events, the Wilcoxon Rank Sum Test was used to compare distribution between groups.

▪ Special thanks to all members of Spartanburg Regional Healthcare System that contributed to patient care. ▪ IRB approval by The Spartanburg Regional Healthcare System IRB (IRB #: 1849618) effective on October 25 th , 2022.

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