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Current practices for treatment of respiratory syncytial virus and other non‐influenza respiratory viruses in high‐risk patient populations: a survey of institutions in the Midwestern Respiratory Virus Collaborative
Author(s) -
Beaird O.E.,
Freifeld A.,
Ison M.G.,
Lawrence S.J.,
Theodoropoulos N.,
Clark N.M.,
Razonable R.R.,
Alangaden G.,
Miller R.,
Smith J.,
Young J.A.H.,
Hawkinson D.,
Pursell K.,
Kaul D.R.
Publication year - 2016
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.12510
Subject(s) - medicine , human metapneumovirus , ribavirin , lower respiratory tract infection , respiratory tract infections , hematopoietic stem cell transplantation , respiratory system , transplantation , immunology , virus , hepatitis c virus
Background The optimal treatment for respiratory syncytial virus ( RSV ) infection in adult immunocompromised patients is unknown. We assessed the management of RSV and other non‐influenza respiratory viruses in Midwestern transplant centers. Methods A survey assessing strategies for RSV and other non‐influenza respiratory viral infections was sent to 13 centers. Results Multiplex polymerase chain reaction assay was used for diagnosis in 11/12 centers. Eight of 12 centers used inhaled ribavirin ( RBV ) in some patient populations. Barriers included cost, safety, lack of evidence, and inconvenience. Six of 12 used intravenous immunoglobulin ( IVIG ), mostly in combination with RBV . Inhaled RBV was used more than oral, and in the post‐stem cell transplant population, patients with lower respiratory tract infection ( LRTI ), graft‐versus‐host disease, and more recent transplantation were treated at higher rates. Ten centers had experience with lung transplant patients; all used either oral or inhaled RBV for LRTI , 6/10 treated upper respiratory tract infection ( URTI ). No center treated non‐lung solid organ transplant ( SOT ) recipients with URTI ; 7/11 would use oral or inhaled RBV in the same group with LRTI . Patients with hematologic malignancy without hematopoietic stem cell transplantation were treated with RBV at a similar frequency to non‐lung SOT recipients. Three of 12 centers, in severe cases, treated parainfluenza and metapneumovirus, and 1/12 treated coronavirus. Conclusions Treatment of RSV in immunocompromised patients varied greatly. While most centers treat LRTI , treatment of URTI was variable. No consensus was found regarding the use of oral versus inhaled RBV , or the use of IVIG . The presence of such heterogeneity demonstrates the need for further studies defining optimal treatment of RSV in immunocompromised hosts.