Clinical impact of healthcare-associated respiratory syncytial virus in hospitalized adults

Abstract

Objective: To describe the clinical impact of healthcare-associated (HA) respiratory syncytial virus (RSV) in hospitalized adults. Design: Retrospective cohort study within a prospective, population-based, surveillance study of RSV-infected hospitalized adults during 3 respiratory seasons: October 2017–April 2018, October 2018–April 2019, and October 2019–March 2020. Setting: The study was conducted in 2 academically affiliated medical centers. Patients: Each HA-RSV patient (in whom RSV was detected by PCR test ≥4 days after hospital admission) was matched (age, sex, season) with 2 community-onset (CO) RSV patients (in whom RSV was detected ≤3 days of admission). Methods: Risk factors and outcomes were compared among HA-RSV versus CO-RSV patients using conditional logistic regression. Escalation of respiratory support associated with RSV detection (day 0) from day −2 to day +4 was explored among HA-RSV patients. Results: In total, 84 HA-RSV patients were matched to 160 CO-RSV patients. In HA-RSV patients, chronic kidney disease was more common, while chronic respiratory conditions and obesity were less common. HA-RSV patients were not more likely to be admitted to an ICU or require mechanical ventilation, but they more often required a higher level of care at discharge compared with CO-RSV patients (44% vs 14%, respectively). Also, 29% of evaluable HA-RSV patients required respiratory support escalation; these patients were older and more likely to have respiratory comorbidities, to have been admitted to intensive care, and to die during hospitalization. Conclusions: HA-RSV in adults may be associated with escalation in respiratory support and an increased level of support in living situation at discharge. Infection prevention and control strategies and RSV vaccination of high-risk adults could mitigate the risk of HA-RSV.

Vaccination for Respiratory Syncytial Virus: A Narrative Review and Primer for Clinicians

“…Nosocomial transmission of RSV should be prevented via strict infection control, as outcomes of healthcare-associated RSV infection may be worse than in community-acquired infections. For instance, in a population-based, surveillance study of RSV-infected hospitalized adults, healthcare-associated infections required a higher level of care at discharge (i.e., placement in a skilled nursing or rehabilitation facility) compared with community-acquired infections (44% vs. 14%) [ 45 ].…”

Respiratory Syncytial Virus incidence and typing in the last 6 seasons in the north of Spain (Asturias). Genetic characterization during the SARS-Cov-2 pandemic

“…RSV may be associated with escalation in respiratory support and an increased level of support in living situation at discharge 23 . RSV disease burden in adults aged more than 60 years in high-income countries is higher than previously estimated 24 .…”

Healthcare-Associated Respiratory Syncytial Virus in Children’s Hospitals

“…Defined as one of the following: change from room air to supplemental oxygen (O 2 ), increase in the fractional inspired (Fi)O 2 on the same non-invasive respiratory support modality, change from non-invasive to invasive respiratory support, or increase in FiO 2 and/or mean airway pressure (MAP) on the same invasive modality [ 8 ]. Non-invasive modalities included nasal cannula O 2 , high flow O 2 , continuous positive airway pressure (CPAP), or bi-level positive airway pressure (BiPAP).…”

“…To determine escalation of respiratory support, baseline respiratory support parameters from day −10 to day −3 were compared to respiratory support parameters used from two days before (day −2) the positive RSV test (day 0) to four days after (day +4) the positive RSV test. The interval day −2 to day +4 was considered the timeframe wherein an escalation of respiratory support would likely be due to HA-RSV infection [ 8 , 10 ].…”