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Adult patients with respiratory syncytial virus infection: impact of solid organ and hematopoietic stem cell transplantation on outcomes
Author(s) -
Pilie P.,
Werbel W.A.,
Riddell J.,
Shu X.,
Schaubel D.,
Gregg K.S.
Publication year - 2015
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12409
Subject(s) - medicine , hematopoietic stem cell transplantation , lower respiratory tract infection , retrospective cohort study , odds ratio , intensive care unit , transplantation , ribavirin , cohort , respiratory tract infections , respiratory system , immunology , virus , hepatitis c virus
Background Respiratory syncytial virus ( RSV ) is a common community‐acquired pathogen responsible for a substantial disease burden in adults. We investigated the outcomes after RSV infection in hospitalized adults over a 3‐year period. Methods This single‐center, retrospective study identified 174 patients hospitalized with RSV upper or lower respiratory tract infection ( LRTI ) between January 1, 2009 and June 30, 2012. Clinical data were extracted from medical records. The primary outcome analyzed was all‐cause mortality, defined as death during the index hospital admission. Subjects were divided into 3 groups for comparison: hematopoietic stem cell transplant ( HSCT ) patients, solid organ transplant ( SOT ) patients, and non‐transplant patients. Results In our study, 41/174 (23.6%) were HSCT recipients and 28/174 (16.1%) were SOT recipients. Twelve of 174 (6.9%) died. Death occurred in 2/41 (4.9%) HSCT and 3/28 (10.7%) SOT recipients, compared to 7/106 (6.6%) non‐transplant patients. When compared to the non‐transplant cohort, HSCT and SOT were not found to be significant risk factors for mortality ( P = 0.685 and 0.645, respectively). In multivariate logistic regression, age >60 was associated with mortality ( P = 0.019), while lymphopenia on admission trended toward an association with death ( P = 0.054). HSCT patients were less likely to be admitted to an intensive care unit (odds ratio [ OR ] 0.26, P = 0.04), but were significantly more likely to receive ribavirin therapy ( OR 11.62, P < 0.0001). Conclusion Adults hospitalized with RSV LRTI are at significant risk of mortality, and this risk may be increased in patients age >60 or with lymphopenia on admission. This study did not identify any significant increased mortality or morbidity associated with RSV infection in immune suppressed transplant recipients vs. patients who had not received a transplant.