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Hospitalizations due to acute respiratory tract infections caused by human metapneumovirus in Costa Rican children
Luisana Guier-Bonilla1,2, Adriana Yock-Corrales3, Marco T Vargas-Acuña3
1Posgrado de Pediatría, Sistema de Estudios de Posgrado, Universidad de Costa Rica.
Insights
Human metapneumovirus (hMPV) causes severe respiratory illness in young children, leading to significant hospitalizations in Costa Rica. The study highlights the need for better antimicrobial stewardship due to high antibiotic use in these pediatric cases.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Public Health
Background:
- Human metapneumovirus (hMPV) is a major cause of acute respiratory infections in children globally.
- Prospective studies on hMPV in Latin American children are scarce, with none previously conducted in Costa Rica.
Purpose of the Study:
- To describe the clinical characteristics and outcomes of hMPV-associated hospitalizations in children in Costa Rica.
- To identify risk factors and complications associated with hMPV infection in this population.
Main Methods:
- An observational, descriptive, prospective study was conducted.
- Included were 188 children under 13 years hospitalized with laboratory-confirmed hMPV infection from 2015-2017.
- Diagnosis was confirmed via direct immunofluorescence assay and/or PCR.
Main Results:
- The majority of patients (65%) were under 15 months old, with a median age of 12 months.
- Common underlying conditions included prematurity, recurrent wheeze-asthma, and low birth weight.
- Significant morbidity was observed, with 37.5% experiencing complications, 28.7% requiring PICU admission, and 14.8% needing mechanical ventilation. Over half (52.6%) received intravenous antibiotics.
Conclusions:
- hMPV hospitalizations in Costa Rican children are linked to substantial morbidity.
- A high rate of antibiotic use was noted, emphasizing the need for antimicrobial stewardship interventions.
- Further research and targeted interventions are warranted to mitigate the impact of hMPV in this region.
Background:
Human metapneumovirus (hMPV) is a leading cause of acute respiratory infection in children, particularly early in life. Despite this, there are few prospective hMPV studies in Latin American children and this is the only of that kind in Costa Rica.
Methods:
We conducted an observational descriptive prospective study at the only national tertiary referral pediatric hospital of the country. We included children < 13 years of age with a laboratory-confirmed hMPV episode of acute respiratory tract infection requiring hospitalization from September 1, 2015, to September 30, 2017. Diagnosis was confirmed by direct immunofluorescence assay and/or polymerase-chain reaction.
Results:
One hundred and eighty-eight patients were analyzed. One hundred and sixteen (62%) were male. About 65% were < 15 months of age; median age was 12 months (interquartile range [IQR] = 6-23). Median hospital stay was 5 days (IQR = 3-8). The most common underlying conditions were prematurity (21.8%;41), recurrent wheeze-asthma (22,8%;43), and low birth weight (17%;32). About 52.6% patients received intravenous antibiotics. Complications occurred in 37.5%, among which, ventilatory failure occurred in 17% (32), shock 4.2% (8), and pleural effusion 1.6% (3). Forty-five (23.9%) patients needed high-flow nasal cannula (average of 3.4 days [standard deviation (SD) = 2.08]). Fifty-four (28.7%) children required pediatric intensive care unit admission. Twenty-eight (14.8%) of them were on assisted mechanical ventilation for a mean duration of 6.3 days (SD = 6.03). Ten patients went home with requiring supplementary oxygen; no deaths occurred.
Conclusions:
hMPV-associated hospitalizations in Costa Rican children are associated with significant morbidity. A concerning finding in our study was the high proportion of patients requiring antibiotic therapy, either on admission or during hospitalization. This should prompt us to antimicrobial stewardship interventions.
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