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Pediatrik yoğun bakımda viral solunum yolu enfeksiyonlarının epidemiyolojisi: Türkiye'den tek merkezli bir çalışma

Year 2025, Volume: 8 Issue: 6, 1099 - 1104, 25.10.2025

Abstract

Amaç:
Bu çalışma, Malatya Eğitim ve Araştırma Hastanesi Çocuk Yoğun Bakım Ünitesi'nde (ÇYBÜ) 2024 yılı boyunca solunum yolu enfeksiyonu tanısıyla izlenen çocuk hastalarda viral etkenlerin dağılımını ve bu etkenlerin klinik parametrelerle ilişkisini değerlendirmeyi amaçlamaktadır.
Yöntem:
Retrospektif olarak planlanan bu gözlemsel çalışmaya 1 Ocak – 31 Aralık 2024 tarihleri arasında solunum yolu enfeksiyonu ön tanısı ile ÇYBÜ’ne yatırılan 257 hasta dahil edilmiştir. Hastalardan elde edilen nazofaringeal sürüntü örnekleri multiplex PCR yöntemi ile analiz edilmiştir. Hastaların demografik bilgileri, laboratuvar verileri ve klinik seyri kayıt altına alınarak istatistiksel analizler yapılmıştır.
Bulgular:
En sık saptanan viral etkenler rinovirüs/enterovirüs (%36,6) ve RSV (%31,5) olmuştur. Komorbidite oranı %38,1 olarak tespit edilmiştir. RSV enfeksiyonları, rinovirüse kıyasla anlamlı olarak daha uzun yoğun bakım yatışı ile ilişkilendirilmiştir (ortalama 6,8 gün iken rinovirüs grubunda 4,3 gündü, p=0.008). Çoklu regresyon analizine göre yaş, CRP düzeyi ve komorbidite varlığı yatış süresini anlamlı derecede etkileyen faktörler olarak belirlendi (p<0.05).
Sonuç:
Rinovirüs/enterovirüs ve RSV, ÇYBÜ hastalarında en yaygın viral solunum yolu etkenleridir. RSV enfeksiyonu daha uzun yatış süresi ile ilişkilidir. CRP yüksekliği ve komorbid hastalık varlığı da klinik seyri olumsuz yönde etkilemektedir. Bu bulgular, pediatrik yoğun bakım yönetiminde hızlı tanı ve risk faktörlerinin göz önünde bulundurulmasının önemini vurgulamaktadır.

References

  • Troeger C, Blacker B, Khalil IA, et al. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis. 2018;18(11):1191-1210.
  • Killien EY, Keller MR, Watson RS, Hartman ME. Epidemiology of intensive care admissions for children in the US from 2001 to 2019. JAMA Pediatr. 2023;177(5):506-515. doi:10.1001/jamapediatrics.2023.0184
  • Li Y, Wang X, Blau DM, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis. Lancet. 2022;399(10340):2047-2064. doi:10.1016/ S0140-6736 (22)00478-0
  • Perez A, Lively JY, Curns A, et al. Respiratory virus surveillance among children with acute respiratory illnesses-new vaccine surveillance network, United States, 2016-2021. Morb Mortal Wkly Rep. 2022;71(40): 1253-1259.
  • Meissner HC. Viral bronchiolitis in children. N Engl J Med. 2016;374(1): 62-72. doi:10.1056/NEJMra1413456
  • 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
  • Brendish NJ, Malachira AK, Armstrong L, et al. Routine molecular point-of-care testing for respiratory viruses in adults presenting to hospital with acute respiratory illness (ResPOC): a pragmatic, open-label, randomized controlled trial. Lancet Respir Med. 2017;5(5):401-411. doi:10.1016/S2213-2600(17)30120-0
  • Esen AB, Erol M, Kafadar D, et al. Progression of disease and viral agents in infants hospitalized for lower respiratory tract infections. J Pediatr Res. 2019;6(4):314-321. doi:10.4274/jpr.galenos.2019.25348
  • Mahony JB. Detection of respiratory viruses by molecular methods. Clin Microbiol Rev. 2008;21(4):716-747. doi:10.1128/cmr.00037-07
  • Lin CY, Hwang D, Chiu NC, et al. Increased detection of viruses in children with respiratory tract infection using PCR. Int J Environment Res Public Health. 2020;17(2):564. doi: 10.3390/ijerph17020564
  • Esposito S, Mencacci A, Cenci E, Camilloni B, Silvestri E, Principi N. Multiplex platforms for the identification of respiratory pathogens: are they useful in pediatric clinical practice? Front Cell Infect Microbiol. 2019;9:196. doi:10.3389/fcimb.2019.00196
  • Clark TW, Lindsley K, Wigmosta TB, et al. Rapid multiplex PCR for respiratory viruses reduces time to result and improves clinical care: results of a systematic review and meta-analysis. J Infect. 2023;86(5):462-475. doi:10.1016/j.jinf.2023.03.005
  • Ljubin-Sternak S, Meštrović T. Rhinovirus-A true respiratory threat or a common inconvenience of childhood? Viruses. 2023;15(4):825. doi:10. 3390/v15040825
  • Calvo C, García-García ML, Blanco C, et al. Multiple simultaneous viral infections in infants with acute respiratory tract infections in Spain. J Clin Virol. 2008;42(3):268-272. doi:10.1016/j.jcv.2008.03.012
  • Heikkinen T, Järvinen A. The common cold. Lancet. 2003;361(9351):51-59. doi:10.1016/S0140-6736(03)12162-9
  • Pneumonia Etiology Research for Child Health (PERCH) Study Group. Causes of severe pneumonia requiring hospital admission in children without HIV infection from Africa and Asia: the PERCH multi-country case-control study. Lancet. 2019;394(10200):757-779. doi:10.1016/S0140-6736(19)30721-4
  • Jacobs SE, Lamson DM, St George K, Walsh TJ. Human rhinoviruses. Clin Microbiol Rev. 2013;26(1):135-162. doi:10.1128/CMR.00077-12
  • Ghazaly M, Nadel S. Characteristics of children admitted to intensive care with acute bronchiolitis. Eur J Pediatr. 2018;177(6):913-920. doi:10. 1007/s00431-018-3138-6
  • Havdal LB, Bøås H, Bekkevold T, et al. Risk factors associated with severe disease in respiratory syncytial virus infected children under 5 years of age. Front Pediatr. 2022;10:1004739. doi:10.3389/fped.2022.1004739
  • Kirolos N, Mtaweh H, Datta RR, et al. Risk factors for severe disease among children hospitalized with respiratory syncytial virus. JAMA Netw Open. 2025;8(4):e254666. doi:10.1001/jamanetworkopen.2025.4666
  • Lei C, Yang L, Lou CT, et al. Viral etiology and epidemiology of pediatric patients hospitalized for acute respiratory tract infections in Macao: a retrospective study from 2014 to 2017. BMC Infect Dis. 2021;21(1):1-11. doi:10.1186/s12879-021-05996-x
  • Yüksel H, Yilmaz O, Akçali S, et al. Common viral etiologies of community acquired lower respiratory tract infections in young children and their relationship with long term complications. Mikrobiyol Bul. 2008;42(3):429-435.
  • Pelit S, Bayraktar B, Bulut ME, Karabulut ND, Nuhoglu A. Investigation of viral agents in lower respiratory tract infections of children by immunofluorescent and immunochromatographic methods. Şişli Etfal Hastanesi Tip Bülteni, 2015;49(2):118.
  • Khales P, Razizadeh MH, Ghorbani S, Moattari A, Saadati H, Tavakoli A. Prevalence of respiratory viruses in children with respiratory tract infections during the COVID-19 pandemic era: a systematic review and meta-analysis. BMC Pulm Med. 2025;25(1):135. doi:10.1186/s12890-025-03587-z
  • Şık G, Demirbuğa A, Annayev A, Cabiri A, Deliceo E, Çıtak A. Frequency of viral pathogens and clinical characteristics of patients hospitalized with lower respiratory tract infection in pediatric intensive care unit. J Pediatr Infect. 2020;14(1):27-32. doi:10.5578/ced.202011
  • Scotta MC, Chakr VC, de Moura A, et al. Respiratory viral coinfection and disease severity in children: a systematic review and meta-analysis. J Clin Virol. 2016;80:45-56. doi:10.1016/j.jcv.2016.04.019
  • Zumla A. Killer respiratory tract infections: time to turn the tide. Curr Opin Pulm Med. 2012;18(3):173-174. Available from: doi:10.1097/MCP.0b013e328351f7d8
  • Jain S, Williams DJ, Arnold SR, et al. Community-acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med. 2015; 372(9):835-845. doi:10.1056/NEJMoa1405870
  • Tregoning JS, Schwarze J. Respiratory viral infections in infants: causes, clinical symptoms, virology, and immunology. Clin Microbiol Rev. 2010; 23(1):74-98. doi:10.1128/cmr.00032-09?download=true
  • Berry JG, Hall M, Hall DE, et al. Inpatient growth and resource use in 28 children’s hospitals: a longitudinal, multi-institutional study. JAMA Pediatr. 2013;167(2):170-177. doi:10.1001/jamapediatrics.2013.432
  • Krishnamurthy K, King R, Oredein B, et al. Admission trends, associated factors and the outcomes for children hospitalised to paediatric intensive care unit for asthma-a population based longitudinal study. Karnataka Paediatr J. 2025;39(4):125-129. doi:10.25259/KPJ_22_2024
  • Hatipoğlu S, Arica S, Çelik Y, et al. Frequency and clinical characteristics of RSV infection in patients hospitalized with lower respiratory tract infection. Duzce Med J. 2009;11(1):38-44.
  • Kudo E, Song E, Yockey LJ, et al. Low ambient humidity impairs barrier function and innate resistance against influenza infection. Proc Natl Acad Sci U S A. 2019;166(22):10905-10910. doi:10.1073/pnas. 1902840116?download=true
  • Griffiths C, Drews SJ, Marchant DJ. Respiratory syncytial virus: infection, detection, and new options for prevention and treatment. Clin Microbiol Rev. 2017;30(1):277-319. doi:10.1128/CMR.00010-16
  • Hammitt LL, Dagan R, Yuan Y, et al. Nirsevimab for prevention of RSV in healthy late-preterm and term infants. N Engl J Med. 2022;386(9):837-846. doi:10.1056/NEJMoa2110275

Epidemiology of viral respiratory tract infections in pediatric ICU: a single-center study in Turkiye

Year 2025, Volume: 8 Issue: 6, 1099 - 1104, 25.10.2025

Abstract

Aims: This study aims to evaluate the distribution of viral agents and their relationship with clinical parameters in pediatric patients with respiratory tract infections in the pediatric intensive care unit (PICU) of MALATYA Training and Research Hospital during 2024.
Methods: This retrospective observational study included 257 patients admitted to the PICU with a prediagnosis of respiratory tract infection between January 1 and December 31, 2024. Nasopharyngeal swab samples obtained from the patients were analyzed by multiplex PCR method. Demographic data, laboratory data and clinical course of the patients were recorded and statistical analysis was performed.
Results: The most common viral agents were rhinovirus/enterovirus (36.6%) and respiratory syncytial virus (RSV) (31.5%). The comorbidity rate was 38.1%. RSV infections were associated with significantly longer ICU stay compared to rhinovirus (mean 6.8 days vs. 4.3 days in the rhinovirus group, p=0.008). According to multiple regression analysis, age, CRP level and presence of comorbidities were determined as factors that significantly affected the length of stay (p<0.05).
Conclusion: Rhinovirus/enterovirus and RSV are the most common viral respiratory tract agents in PICU patients. RSV infection is associated with longer hospitalization. Elevated CRP and the presence of comorbid diseases also negatively affect the clinical course. These findings emphasize the importance of rapid diagnosis and consideration of risk factors in pediatric intensive care management.

References

  • Troeger C, Blacker B, Khalil IA, et al. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis. 2018;18(11):1191-1210.
  • Killien EY, Keller MR, Watson RS, Hartman ME. Epidemiology of intensive care admissions for children in the US from 2001 to 2019. JAMA Pediatr. 2023;177(5):506-515. doi:10.1001/jamapediatrics.2023.0184
  • Li Y, Wang X, Blau DM, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis. Lancet. 2022;399(10340):2047-2064. doi:10.1016/ S0140-6736 (22)00478-0
  • Perez A, Lively JY, Curns A, et al. Respiratory virus surveillance among children with acute respiratory illnesses-new vaccine surveillance network, United States, 2016-2021. Morb Mortal Wkly Rep. 2022;71(40): 1253-1259.
  • Meissner HC. Viral bronchiolitis in children. N Engl J Med. 2016;374(1): 62-72. doi:10.1056/NEJMra1413456
  • 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
  • Brendish NJ, Malachira AK, Armstrong L, et al. Routine molecular point-of-care testing for respiratory viruses in adults presenting to hospital with acute respiratory illness (ResPOC): a pragmatic, open-label, randomized controlled trial. Lancet Respir Med. 2017;5(5):401-411. doi:10.1016/S2213-2600(17)30120-0
  • Esen AB, Erol M, Kafadar D, et al. Progression of disease and viral agents in infants hospitalized for lower respiratory tract infections. J Pediatr Res. 2019;6(4):314-321. doi:10.4274/jpr.galenos.2019.25348
  • Mahony JB. Detection of respiratory viruses by molecular methods. Clin Microbiol Rev. 2008;21(4):716-747. doi:10.1128/cmr.00037-07
  • Lin CY, Hwang D, Chiu NC, et al. Increased detection of viruses in children with respiratory tract infection using PCR. Int J Environment Res Public Health. 2020;17(2):564. doi: 10.3390/ijerph17020564
  • Esposito S, Mencacci A, Cenci E, Camilloni B, Silvestri E, Principi N. Multiplex platforms for the identification of respiratory pathogens: are they useful in pediatric clinical practice? Front Cell Infect Microbiol. 2019;9:196. doi:10.3389/fcimb.2019.00196
  • Clark TW, Lindsley K, Wigmosta TB, et al. Rapid multiplex PCR for respiratory viruses reduces time to result and improves clinical care: results of a systematic review and meta-analysis. J Infect. 2023;86(5):462-475. doi:10.1016/j.jinf.2023.03.005
  • Ljubin-Sternak S, Meštrović T. Rhinovirus-A true respiratory threat or a common inconvenience of childhood? Viruses. 2023;15(4):825. doi:10. 3390/v15040825
  • Calvo C, García-García ML, Blanco C, et al. Multiple simultaneous viral infections in infants with acute respiratory tract infections in Spain. J Clin Virol. 2008;42(3):268-272. doi:10.1016/j.jcv.2008.03.012
  • Heikkinen T, Järvinen A. The common cold. Lancet. 2003;361(9351):51-59. doi:10.1016/S0140-6736(03)12162-9
  • Pneumonia Etiology Research for Child Health (PERCH) Study Group. Causes of severe pneumonia requiring hospital admission in children without HIV infection from Africa and Asia: the PERCH multi-country case-control study. Lancet. 2019;394(10200):757-779. doi:10.1016/S0140-6736(19)30721-4
  • Jacobs SE, Lamson DM, St George K, Walsh TJ. Human rhinoviruses. Clin Microbiol Rev. 2013;26(1):135-162. doi:10.1128/CMR.00077-12
  • Ghazaly M, Nadel S. Characteristics of children admitted to intensive care with acute bronchiolitis. Eur J Pediatr. 2018;177(6):913-920. doi:10. 1007/s00431-018-3138-6
  • Havdal LB, Bøås H, Bekkevold T, et al. Risk factors associated with severe disease in respiratory syncytial virus infected children under 5 years of age. Front Pediatr. 2022;10:1004739. doi:10.3389/fped.2022.1004739
  • Kirolos N, Mtaweh H, Datta RR, et al. Risk factors for severe disease among children hospitalized with respiratory syncytial virus. JAMA Netw Open. 2025;8(4):e254666. doi:10.1001/jamanetworkopen.2025.4666
  • Lei C, Yang L, Lou CT, et al. Viral etiology and epidemiology of pediatric patients hospitalized for acute respiratory tract infections in Macao: a retrospective study from 2014 to 2017. BMC Infect Dis. 2021;21(1):1-11. doi:10.1186/s12879-021-05996-x
  • Yüksel H, Yilmaz O, Akçali S, et al. Common viral etiologies of community acquired lower respiratory tract infections in young children and their relationship with long term complications. Mikrobiyol Bul. 2008;42(3):429-435.
  • Pelit S, Bayraktar B, Bulut ME, Karabulut ND, Nuhoglu A. Investigation of viral agents in lower respiratory tract infections of children by immunofluorescent and immunochromatographic methods. Şişli Etfal Hastanesi Tip Bülteni, 2015;49(2):118.
  • Khales P, Razizadeh MH, Ghorbani S, Moattari A, Saadati H, Tavakoli A. Prevalence of respiratory viruses in children with respiratory tract infections during the COVID-19 pandemic era: a systematic review and meta-analysis. BMC Pulm Med. 2025;25(1):135. doi:10.1186/s12890-025-03587-z
  • Şık G, Demirbuğa A, Annayev A, Cabiri A, Deliceo E, Çıtak A. Frequency of viral pathogens and clinical characteristics of patients hospitalized with lower respiratory tract infection in pediatric intensive care unit. J Pediatr Infect. 2020;14(1):27-32. doi:10.5578/ced.202011
  • Scotta MC, Chakr VC, de Moura A, et al. Respiratory viral coinfection and disease severity in children: a systematic review and meta-analysis. J Clin Virol. 2016;80:45-56. doi:10.1016/j.jcv.2016.04.019
  • Zumla A. Killer respiratory tract infections: time to turn the tide. Curr Opin Pulm Med. 2012;18(3):173-174. Available from: doi:10.1097/MCP.0b013e328351f7d8
  • Jain S, Williams DJ, Arnold SR, et al. Community-acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med. 2015; 372(9):835-845. doi:10.1056/NEJMoa1405870
  • Tregoning JS, Schwarze J. Respiratory viral infections in infants: causes, clinical symptoms, virology, and immunology. Clin Microbiol Rev. 2010; 23(1):74-98. doi:10.1128/cmr.00032-09?download=true
  • Berry JG, Hall M, Hall DE, et al. Inpatient growth and resource use in 28 children’s hospitals: a longitudinal, multi-institutional study. JAMA Pediatr. 2013;167(2):170-177. doi:10.1001/jamapediatrics.2013.432
  • Krishnamurthy K, King R, Oredein B, et al. Admission trends, associated factors and the outcomes for children hospitalised to paediatric intensive care unit for asthma-a population based longitudinal study. Karnataka Paediatr J. 2025;39(4):125-129. doi:10.25259/KPJ_22_2024
  • Hatipoğlu S, Arica S, Çelik Y, et al. Frequency and clinical characteristics of RSV infection in patients hospitalized with lower respiratory tract infection. Duzce Med J. 2009;11(1):38-44.
  • Kudo E, Song E, Yockey LJ, et al. Low ambient humidity impairs barrier function and innate resistance against influenza infection. Proc Natl Acad Sci U S A. 2019;166(22):10905-10910. doi:10.1073/pnas. 1902840116?download=true
  • Griffiths C, Drews SJ, Marchant DJ. Respiratory syncytial virus: infection, detection, and new options for prevention and treatment. Clin Microbiol Rev. 2017;30(1):277-319. doi:10.1128/CMR.00010-16
  • Hammitt LL, Dagan R, Yuan Y, et al. Nirsevimab for prevention of RSV in healthy late-preterm and term infants. N Engl J Med. 2022;386(9):837-846. doi:10.1056/NEJMoa2110275
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Details

Primary Language English
Subjects Pediatric Intensive Care
Journal Section Original Article
Authors

Abdulgani Gülyüz 0000-0001-5797-9115

Nazan Poyraz 0009-0008-6586-6610

Sıla Yaldız Ataş 0009-0004-7046-2910

Publication Date October 25, 2025
Submission Date August 6, 2025
Acceptance Date October 10, 2025
Published in Issue Year 2025 Volume: 8 Issue: 6

Cite

AMA Gülyüz A, Poyraz N, Yaldız Ataş S. Epidemiology of viral respiratory tract infections in pediatric ICU: a single-center study in Turkiye. J Health Sci Med / JHSM. October 2025;8(6):1099-1104.

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