Respiratory syncytial virus infection-associated hospitalization in adults: a retrospective cohort study

Abstract

BackgroundOnce considered primarily a pediatric concern, respiratory syncytial virus (RSV) infection is gaining recognition as a cause of significant morbidity and mortality in adults. A better understanding of RSV epidemiology and disease in adults is needed to guide patient management and to assess the need for prophylaxis, vaccines, and treatments.MethodsWe conducted a retrospective cohort study of adults admitted to four hospitals in Toronto, Canada, between September 2012 and June 2013 with RSV identified by a qualitative real-time reverse-transcriptase polymerase chain reaction assay in nasopharyngeal swab or bronchoscopy specimens. Main outcomes were hospital length of stay, need for intensive care unit (ICU) or mechanical ventilation, and all-cause mortality.ResultsEighty-six patients were identified as requiring hospitalization for RSV infection (56% female). Median age was 74 (range 19–102) years; 29 (34%) were < 65 years. Eighty-three (97%) had underlying chronic medical conditions; 27 (31%) were immunosuppressed, and 10 (12%) known smokers. The most common symptoms and signs were cough in 73 (85%), shortness of breath in 68 (79%), sputum production in 54 (63%), weakness in 43 (50%), fever in 41 (48%), and wheezing in 33 (38%). Lower respiratory tract complications occurred in 45 (52%), cardiovascular complications occurred in 19 (22%), and possible co-pathogens were identified in 11 (13%). Sixty-seven (78%) were treated with antibiotics and 31 (36%) with anti-influenza therapy. Thirteen (15%) required ICU care and 8 (9%) required mechanical ventilation. Five (6%) died during hospitalization. Need for ICU and mechanical ventilation were associated with mortality (P ≤ 0.02). Median hospital length of stay was 6 days (mean 10.8 days).ConclusionsRSV infection is associated with the need for extended hospital stay, ICU care and mortality in adults of all ages with chronic underlying conditions. Presenting signs and symptoms are nonspecific, co-infections occur, and patients often receive antibiotics and anti-influenza therapy. There is need for ongoing research and development of RSV prophylaxis, vaccines and treatments for adults.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0665-2) contains supplementary material, which is available to authorized users.

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

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“…RSV is also common in adults, especially the elderly and other high‐risk groups such as those who are immunocompromised 4, 5, 6. RSV outbreaks among vulnerable hospitalised patients are of particular concern as affected patients are more likely to experience longer hospital stays, with increased risk of morbidity and mortality 4, 7, 8. Numerous hospital outbreaks have been reported in multiple age groups and settings including neonatal intensive care, haematology, transplant and oncology units 9, 10, 11, 12…”

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