Delayed Diagnosis of Respiratory Syncytial Virus Infections in Hospitalized Adults: Individual Patient Data, Record Review Analysis and Physician Survey in the United States

Overview

Journal J Infect Dis

Publisher Oxford University Press

Specialty Infectious Diseases

Date 2019 May 10

PMID 31070757

Citations 14

Authors

Nelson Lee

Edward E Walsh

Ian Sander

Robert Stolper

Jessica Zakar

Veronique Wyffels

David Myers

Roman Fleischhackl

Affiliations

Soon will be listed here.

Abstract

Background: Despite the prevalence of respiratory syncytial virus (RSV) in adults hospitalized with acute respiratory infections, guidelines for the diagnosis and management of RSV have not been established. This analysis evaluated the role and timeliness of RSV diagnostic testing and its potential impact on clinical outcomes.

Methods: We analyzed individual patient data from hospitalized adults with confirmed RSV infections during 2 North American RSV seasons. Participating physicians reported clinical, virologic diagnosis, and outcome variables using a standardized online case form.

Results: Across 32 US states, 132 physicians reported 379 RSV cases. Polymerase chain reaction-based diagnostics were the most common type of test ordered (94.2%) with <5% ordered specifically to diagnose RSV. Most tests (67.6%) were ordered in hospital wards or intensive care units. Overall, 47.4%, 30.9%, and 21.7% of patients had RSV diagnosed <12, 12‒24, and >24 hours after hospital admission, respectively. Later diagnosis was associated with longer hospital stays (n = 145; R = +0.191; P < .05) and greater antibiotic use.

Conclusion: Diagnosis of RSV infection in hospitalized adults is often delayed, which may affect clinical management and outcomes. Our findings indicate the need to improve the diagnostic strategies in this patient population.

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References

Falsey A, Hennessey P, Formica M, Cox C, Walsh E . Respiratory syncytial virus infection in elderly and high-risk adults. N Engl J Med. 2005; 352(17):1749-59. DOI: 10.1056/NEJMoa043951. View

Hynicka L, Ensor C . Prophylaxis and treatment of respiratory syncytial virus in adult immunocompromised patients. Ann Pharmacother. 2012; 46(4):558-66. DOI: 10.1345/aph.1Q553. View

Zhou H, Thompson W, Viboud C, Ringholz C, Cheng P, Steiner C . Hospitalizations associated with influenza and respiratory syncytial virus in the United States, 1993-2008. Clin Infect Dis. 2012; 54(10):1427-36. PMC: 3334364. DOI: 10.1093/cid/cis211. View

Widmer K, Zhu Y, Williams J, Griffin M, Edwards K, Talbot H . Rates of hospitalizations for respiratory syncytial virus, human metapneumovirus, and influenza virus in older adults. J Infect Dis. 2012; 206(1):56-62. PMC: 3415933. DOI: 10.1093/infdis/jis309. View

Lee N, Lui G, Wong K, Li T, Tse E, Chan J . High morbidity and mortality in adults hospitalized for respiratory syncytial virus infections. Clin Infect Dis. 2013; 57(8):1069-77. DOI: 10.1093/cid/cit471. View

Falsey A, McElhaney J, Beran J, van Essen G, Duval X, Esen M . Respiratory syncytial virus and other respiratory viral infections in older adults with moderate to severe influenza-like illness. J Infect Dis. 2014; 209(12):1873-81. PMC: 4038137. DOI: 10.1093/infdis/jit839. View

Matias G, Taylor R, Haguinet F, Schuck-Paim C, Lustig R, Shinde V . Estimates of mortality attributable to influenza and RSV in the United States during 1997-2009 by influenza type or subtype, age, cause of death, and risk status. Influenza Other Respir Viruses. 2014; 8(5):507-15. PMC: 4181813. DOI: 10.1111/irv.12258. View

McClure D, Kieke B, Sundaram M, Simpson M, Meece J, Sifakis F . Seasonal incidence of medically attended respiratory syncytial virus infection in a community cohort of adults ≥50 years old. PLoS One. 2014; 9(7):e102586. PMC: 4099308. DOI: 10.1371/journal.pone.0102586. View

Rogers B, Shankar P, Jerris R, Kotzbauer D, Anderson E, Watson J . Impact of a rapid respiratory panel test on patient outcomes. Arch Pathol Lab Med. 2014; 139(5):636-41. DOI: 10.5858/arpa.2014-0257-OA. View

10.

Simoes E, DeVincenzo J, Boeckh M, Bont L, Crowe Jr J, Griffiths P . Challenges and opportunities in developing respiratory syncytial virus therapeutics. J Infect Dis. 2015; 211 Suppl 1:S1-S20. PMC: 4345819. DOI: 10.1093/infdis/jiu828. View

11.

Dugas A, Valsamakis A, Atreya M, Thind K, Manchego P, Faisal A . Clinical diagnosis of influenza in the ED. Am J Emerg Med. 2015; 33(6):770-5. PMC: 4458223. DOI: 10.1016/j.ajem.2015.03.008. View

12.

Branche A, Falsey A . Respiratory syncytial virus infection in older adults: an under-recognized problem. Drugs Aging. 2015; 32(4):261-9. DOI: 10.1007/s40266-015-0258-9. View

13.

Goldstein E, Greene S, Olson D, Hanage W, Lipsitch M . Estimating the hospitalization burden associated with influenza and respiratory syncytial virus in New York City, 2003-2011. Influenza Other Respir Viruses. 2015; 9(5):225-33. PMC: 4548992. DOI: 10.1111/irv.12325. View

14.

Pilie P, Werbel W, Riddell 4th J, Shu X, Schaubel D, Gregg K . Adult patients with respiratory syncytial virus infection: impact of solid organ and hematopoietic stem cell transplantation on outcomes. Transpl Infect Dis. 2015; 17(4):551-7. DOI: 10.1111/tid.12409. View

15.

Brendish N, Schiff H, Clark T . Point-of-care testing for respiratory viruses in adults: The current landscape and future potential. J Infect. 2015; 71(5):501-10. PMC: 7172689. DOI: 10.1016/j.jinf.2015.07.008. View

16.

Fleming D, Taylor R, Lustig R, Schuck-Paim C, Haguinet F, Webb D . Modelling estimates of the burden of Respiratory Syncytial virus infection in adults and the elderly in the United Kingdom. BMC Infect Dis. 2015; 15:443. PMC: 4618996. DOI: 10.1186/s12879-015-1218-z. View

17.

Lacroix S, Vrignaud B, Avril E, Moreau-Klein A, Coste M, Launay E . Impact of rapid influenza diagnostic test on physician estimation of viral infection probability in paediatric emergency department during epidemic period. J Clin Virol. 2015; 72:141-5. DOI: 10.1016/j.jcv.2015.08.002. View

18.

Soto M, Sampietro-Colom L, Vilella A, Pantoja E, Asenjo M, Arjona R . Economic Impact of a New Rapid PCR Assay for Detecting Influenza Virus in an Emergency Department and Hospitalized Patients. PLoS One. 2016; 11(1):e0146620. PMC: 4720278. DOI: 10.1371/journal.pone.0146620. View

19.

Rappo U, Schuetz A, Jenkins S, Calfee D, Walsh T, Wells M . Impact of Early Detection of Respiratory Viruses by Multiplex PCR Assay on Clinical Outcomes in Adult Patients. J Clin Microbiol. 2016; 54(8):2096-103. PMC: 4963510. DOI: 10.1128/JCM.00549-16. View

20.

Saxena S, Singh D, Zia A, Umrao J, Srivastava N, Pandey A . Clinical characterization of influenza A and human respiratory syncytial virus among patients with influenza like illness. J Med Virol. 2016; 89(1):49-54. DOI: 10.1002/jmv.24607. View