Background Although respiratory syncytial virus (RSV) infection continues to be a leading cause of infant hospitalisation with a high transmission rate, recent data on nosocomial RSV infection are scarce. This study investigated the clinical and epidemiological characteristics of nosocomial RSV infection in the palivizumab-prophylaxis era.

Methods The database of a tertiary paediatric medical centre was searched for all hospitalised patients with RSV-positive respiratory disease in 2008 through 2010. Data were compared between patients with community-associated and nosocomial disease and the qualification of the latter group for palivizumab was evaluated.

Results Of the 873 children identified, 30 (3.4%) had a nosocomial infection. This group accounted for 0.06% of all admissions during the study period and 0.13 of every 1000 hospitalisation days. The nosocomial-infection group had higher rates of preterm birth and severe underlying disease than the community-associated RSV group, and a longer mean hospital stay. The nosocomial-infection group also had higher rates of intensive care unit admission and mechanical ventilation. Although 73% had underlying conditions, the vast majority (80%) did not qualify for RSV immunoprophylaxis.

Conclusion Nosocomial RSV infection is a significant cause of morbidity among hospitalised infants, especially those with comorbidities and lengthy hospital stay, and is associated with a complicated clinical course. In addition to strict infection-control measures, extending palivizumab prophylaxis to additional selected high-risk populations should be considered.