Epidemiological and clinical profiles of respiratory syncytial virus infections in hospitalized children: a retrospective cohort study utilizing targeted next-generation sequencing

Abstract

Background: Respiratory syncytial virus (RSV) is a significant cause of respiratory infections in children. Currently, there is limited literature on the clinical use of pathogen-targeted sequencing technologies and the systematic analysis of RSV infections in hospitalized children. The primary objective of this research was to evaluate the infection status and clinical manifestations associated with RSV in these pediatric patients.

Methods: Between July 2021 and November 2023, 5,021 children hospitalized due to respiratory infections or associated complications were enrolled at the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region. Targeted next-generation sequencing (tNGS) was used to detect pathogens in their respiratory samples. Subsequently, the clinical data of children infected with RSV were systematically evaluated.

Results: Of the 5,021 children hospitalized with respiratory infections, RSV was detected in 1,080, yielding a detection rate of 21.5%. Among RSV-positive patients, only 8.6% (93/1080) experienced single infections, while the majority, 91.4% (987/1080), had co-infections with other pathogens. Among the observed infection patterns, RSV-viral-bacterial co-infection was the most prevalent, occurring in 524 cases (48.5%), followed by RSV-viral co-infection in 141 cases (13.1%). Among children with RSV co-infections, 43 additional microorganisms were detected, with cytomegalovirus, Haemophilus influenzae, and Streptococcus pneumoniae being the most prevalent. Of the 1,080 children diagnosed with RSV, 172 (15.9%) required ICU admission for monitoring. The median duration of hospitalization for the 1080 children diagnosed with RSV infection was 8 days. Of these, 1025 (94.9%) patients recovered and were discharged following treatment, while 54 (5.0%) of the patients' family members requested voluntary discharge due to unsatisfactory outcomes or other reasons. Unfortunately, one child (0.1%) died despite receiving intensive medical treatment.

Conclusion: Due to the high incidence of RSV infections and associated ICU admissions, there is a critical need for effective vaccine development to protect infants and children. This study presents a comprehensive analysis of hospitalized pediatric patients with RSV, examining infection patterns, clinical manifestations, laboratory findings, imaging characteristics, complications, and prognosis.

Keywords: Children; Infection; Pathogens; Respiratory syncytial virus; TNGS.