Incidence and viral etiology of hospital-acquired respiratory illness in tertiary care hospitals in Bangladesh.

IntroductionHospital-acquired respiratory infections (HARI) contribute to morbidity and mortality among hospitalised patients, but their viral etiology is poorly characterised in Bangladesh. This analysis estimated the incidence, viral etiology, and outcomes of HARI among hospitalised patients.MethodologyFrom May 2008 to February 2017, we conducted surveillance in adult medicine and pediatric wards of three tertiary hospitals in Bangladesh. Patients who developed respiratory symptoms > 72 hours after hospitalisation were enrolled and tested for influenza (A and B), respiratory syncytial virus (RSV), human parainfluenza virus, and human metapneumovirus by rRT-PCR. Incidence was calculated per 1,000 patient-days at risk using Poisson-based distribution.ResultDuring 187,757 patient-days, 1243 HARI cases were identified (6.6 per 1,000 patient-days; 95% CI: 6.2-7.0), representing 2.6% of admissions. Respiratory viruses were detected in 23% of cases. Incidence was higher in children than adults (29.7 vs 9.5 per 10,000 patient-days). Influenza (6% of adults, 6% of children) and RSV (4.5% of adults, 10% of children) were the most frequently detected viruses. Overall, 3.9% HARI patients died. Clusters accounted for 27% of influenza and 21% of RSV-associated cases.ConclusionDetection of respiratory viruses in HARI cases and their temporal clustering is consistent with possible in-hospital transmission, warranting strengthened infection prevention and improved diagnostic surveillance.