the impact of bacterial co-infection on hospitalized children with human rhinovirus and human metapneumovirus infections: a retrospective analytical cross-sectional study

Background: human rhinovirus (hrv) and human metapneumovirus (hmpv) are common viral causes of pediatric respiratory tract infections. bacterial co-infections frequently complicate hrv and hmpv illnesses in children, but the interactions between viral and bacterial pathogens and their impacts on disease severity are not well understood. objectives: the present research aimed to analyze and compare the clinical features of hrv and hmpv mono-infections in hospitalized children and to assess the impact of bacterial co-infection on the disease severity of hrv and hmpv infections. methods: the present retrospective analytical cross-sectional study was conducted to compare the clinical features between hrv and hmpv mono-infections and hrv and hmpv with bacterial co-infections in hospitalized children aged 14 years or younger. results: between january and december 2022, we investigated 1,978 children hospitalized with hrv infection, of which 1,529 had hrv mono-infection and 1,117 hospitalized with hmpv infection, among whom 910 had hmpv mono-infection. compared to hrv, hmpv mono-infection exhibited more pronounced symptoms of fever, cough, and rales in most age groups, while hrv showed more wheezing. except in patients ≥ 6 years old, hmpv was more associated with pneumonia and longer hospitalizations. in contrast to hrv mono-infections, children with bacterial co-infections had a higher proportion of coughs (p < 0.001), pneumonia (p < 0.001), pediatric intensive care unit (picu) admissions (p < 0.001), and longer hospitalizations (p = 0.003). demographic characteristics, clinical presentation, diagnosis, and treatments showed no significant differences between patients with hmpv mono-infection and co-infection. conclusions: among hospitalized children, hmpv mono-infection resulted in more severe respiratory illnesses compared to hrv mono-infection. bacterial co-infections exacerbated disease severity in hrv infections.