Epidemiology and outcomes of hospitalized adults with respiratory syncytial virus: A 6‐year retrospective study

Abstract

Objectives Respiratory syncytial virus (RSV) is an important cause of morbidity and mortality in adults. Existing studies are limited by the number of seasons studied and most have focused on the immunocompromised. Methods A retrospective cohort study was conducted on all adults (≥18 years) with a positive RSV molecular test admitted from 2009 to 2015 to one hospital in Chicago, IL. Epidemiologic and outcomes data were collected after IRB approval. Results Of the 489 eligible patients, 227 had RSV A and 262 had RSV B. Patients had a median age of 61 years and comorbidity (eg, chronic lung disease [40.6%], obesity [37.8%], and cardiac disease [34.3%]). On presentation, most had cough (86.5%), fever (42.4%), and shortness of breath (38.2%). Severe disease was present in 27.6% of patients. Antibiotic was used in 76.3% inpatients and 45.8% at discharged despite few patients (4.7%) having documented bacterial infections. Supplemental oxygen and mechanical ventilation were utilized in 44.6% and 12.3%, respectively, while ICU level care was required in 26.9%. Most patients were discharged home (82.7%). Most deaths (68.4%, 13/19) were attributed to pneumonia or hypoxemia likely from RSV. Most fatal cases were seen in those with recent cancer treatment and older adults. Conclusions Respiratory syncytial virus in hospitalized adults is associated with significant morbidity and mortality with 26.9% requiring ICU level care. Antibiotics are commonly prescribed to patients with documented RSV, and antibiotics are frequently continued after diagnosis. Novel antiviral therapies are needed for RSV to improve outcomes and potentially improve antibiotic stewardship in patients without a bacterial infection.

Rates of respiratory syncytial virus (RSV)-associated hospitalization among adults with congestive heart failure—United States, 2015–2017

“…Poor health outcomes, including mechanical ventilation, hospitalization, and death, have also been documented previously in adults with RSV and cardiopulmonary disease (e.g., CHF or COPD) or cardiac disease [ 2 , 5 ]. Our finding that a high proportion of patients with CHF also had COPD is consistent with other studies describing pulmonary and cardiac disease comorbidities with RSV infection [ 3 , 6 , 24 , 25 ]. Indeed, having both CHF and COPD might increase the risk for medically attended RSV infection [ 26 ].…”

The burden of respiratory syncytial virus in adults: a systematic review and meta-analysis

“…Older adults and people living with underlying diseases are known to be at a higher risk of respiratory infections, RSV and influenza in particular, compared to healthy young adults. In some studies, RSV infections occurred more frequently than influenza infections and may result in greater morbidity and mortality in transplant and immunocompromised patients, and in patients with chronic respiratory and congestive heart diseases [118, 119]. In our review, about 2–20% of HSCT patients suffered from at least one RSV infection during 1–5 years post transplantation in different prospective cohort studies [87–91].…”

Clinical characteristics and population‐based attack rates of respiratory syncytial virus versus influenza hospitalizations among adults—An observational study

“…Consistently with previous research, the majority (30/31, 97%) of RSV patients had at least one preexisting comorbidity. 22 , 23 , 31 , 33 , 36 , 37 Serious comorbidities (McCabe 2 or 3) were somewhat more common (42% vs. 25%, p = 0.114) among RSV than influenza patients. As in previous studies, chronic kidney diseases were more common among RSV than influenza patients.…”