Etiology of viral respiratory tract infections in hospitalized adults, and evidence of the high frequency of prehospitalization antibiotic treatment in Norway

Abstract

Background and aims Respiratory tract infections (RTIs) cause considerable morbidity and mortality in all age groups, but the epidemiology and role of several of the viral RTIs in the adult and elderly patients are still unclear, as is the extent of prehospitalization antibacterial drug use in this population. Methods We conducted a three‐year (2015‐2018) observational study of viral RTIs in hospitalized patients in a 500‐bed hospital in Southeastern Norway, including all patients ≥18 years with RTI symptoms where one of the following viral agents was detected in a respiratory specimen (Seegene Allplex): Influenza A/B, RSV A/B, human metapneumovirus (hMPV), adenovirus and parainfluenza virus 1‐4. Viral findings, demographical data, and information on prehospital antibiotic prescriptions were recorded. Results In 1182 patients 1222 viral infection events occurred. The mean patient age was 69.6 years, and 53% were females. Influenza virus A/B (63%), RSV A/B (15%) and hMPV (13%) were the most common agents detected. The proportional burden of influenza A H1 was found to be relatively high (65%) in the age groups <69 years, compared to older patients ( P = .001, chi‐square). As many as 20% of the patients had been treated with antibiotics prior to admission, with the lowest rate for influenza A H3 group at 17% ( P = .036, chi‐square), and highest for the RSV group at 28% ( P = .004, chi‐square). Oseltamivir was prescribed prior to hospitalization in only 3 cases (0.2%). Conclusions We found a high rate of prehospital antibiotic prescription in adults hospitalized with viral RTIs, warranting better stewardship programs to tackle the increasing antibiotic resistance problem.

Respiratory Syncytial Virus: Knowledge, Attitudes and Beliefs of General Practitioners from North-Eastern Italy (2021)

“…A possible explanation may be found in the characteristics of this convenience sample and their experience with potentially dismal outcomes of RSV infections. While RSV is potentially associated with severe consequences in infants, irrespective of their health status [ 11 , 68 , 69 ], the majority of annual deaths occur in the elderly [ 10 , 12 , 41 , 42 , 70 , 71 , 72 ], but the causal agent remains undiagnosed in the majority of cases [ 10 , 12 , 40 ]. As most of the participants actually lacked any background in pediatrics, having only a limited daily practice in the management of pediatric infectious diseases, the scarce familiarity with the actual severity of this pathogen may have led them to improperly underscore the specific health risks.…”

“…On the one hand, the only available therapeutic option is represented by supportive care (i.e., respiratory support and management of volume depletion) [ 6 , 11 ]. On the other hand, RSV vaccines are commercially unavailable [ 1 , 3 , 9 , 12 , 13 ], and preventive interventions are limited to monoclonal antibodies (mAb) [ 14 , 15 , 16 ]. Despite their efficacy in avoiding hospitalizations and long-term sequelae, their use is forcibly limited to some high-risk groups (i.e., prematurely-born infants under 6 months of age, and children with certain comorbidities under 2 years of age during the RSV season) [ 9 , 17 , 18 , 19 , 20 , 21 ].…”

Clinical Outcome of Viral Respiratory Tract Infections in Hospitalized Adults in Norway: High Degree of Inflammation and Need of Emergency Care for Cases With Respiratory Syncytial Virus

“…The RSV patients also had higher WBC and CRP levels when compared to influenza A, indicating more severe inflammation. These patients were also treated more often with antibiotics before hospitalization (18), during their stay and at discharge. The influenza B patients less often needed respiratory support than the influenza A patients and were rarely prescribed oseltamivir.…”

“…The next season, (2016/2017), influenza virus A H3 was the most frequent (59%), while RSV counted for 21% of the infection events with RSV subtype B as the dominant subtype. The last season, (2017/2018) was dominated by influenza virus B (45%) and this season accounted for the highest percentage of the infection events when looking at the three seasons (45%) constituting the study period (18).…”

Respiratory Syncytial Virus Prevention through Monoclonal Antibodies: A Cross-Sectional Study on Knowledge, Attitudes, and Practices of Italian Pediatricians

“…On the one hand, no etiological therapy has been made available [ 15 , 19 ]. On the other hand [ 20 ], more than 60 years of intensive research has failed in providing safe and effective vaccines [ 20 ] that still remain commercially unavailable [ 2 , 11 , 16 , 21 , 22 ]. For nearly two decades, the only preventive option available has been therefore based on the passive immunization through the humanized monoclonal antibody (mAb) palivizumab (SYNAGIS ® ; USA approval 1998, EU approval 1999) [ 4 , 23 , 24 , 25 , 26 , 27 ].…”