RESUMO
We aimed to determine the prevalence of bacterial coinfection (CoBact) and bacterial superinfection (SuperBact), the causative pathogens, the initial antibiotic-prescribing practice, and the associated clinical outcomes of hospitalized patients with respiratory syncytial virus-associated acute respiratory illness (RSV-ARI). This retrospective study included 175 adults with RSV-ARI, virologically confirmed via RT-PCR, during the period 2014-2019. Thirty (17.1%) patients had CoBact, and 18 (10.3%) had SuperBact. The independent factors associated with CoBact were invasive mechanical ventilation (OR: 12.1, 95% CI: 4.7-31.4; p < 0.001) and neutrophilia (OR: 3.3, 95% CI: 1.3-8.5; p = 0.01). The independent factors associated with SuperBact were invasive mechanical ventilation (aHR: 7.2, 95% CI: 2.4-21.1; p < 0.001) and systemic corticosteroids (aHR: 3.1, 95% CI: 1.2-8.1; p = 0.02). CoBact was associated with higher mortality compared to patients without CoBact (16.7% vs. 5.5%, p = 0.05). Similarly, SuperBact was associated with higher mortality compared to patients without SuperBact (38.9% vs. 3.8%, p < 0.001). The most common CoBact pathogen identified was Pseudomonas aeruginosa (30%), followed by Staphylococcus aureus (23.3%). The most common SuperBact pathogen identified was Acinetobacter spp. (44.4%), followed by ESBL-positive Enterobacteriaceae (33.3%). Twenty-two (100%) pathogens were potentially drug-resistant bacteria. In patients without CoBact, there was no difference in mortality between patients who received an initial antibiotic treatment of <5 days or ≥5 days.
RESUMO
BACKGROUND: Respiratory syncytial virus (RSV) is an increasingly common cause of respiratory illness in adult non-immunocompromised patients. Oral ribavirin was reported to improve outcomes of RSV infection in immunocompromised patients. This study aimed to determine the outcomes of non-immunocompromised patients hospitalized with RSV-associated acute respiratory illnesses (RSV-ARI), the factors independently associated with the outcomes and the effect of oral ribavirin treatment. METHODS: This retrospective, observational cohort study included 175 adults admitted to the hospital with virologically confirmed RSV-ARI during 2014-2019. Severe ARI was identified using Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) criteria for severe community-acquired pneumonia. The primary outcome was all-cause mortality within 30 days after enrollment. A multivariable Cox model was performed to identify significant predictors of mortality. RESULTS: Mean age was 76 ± 12.7 years. Seventy-eight (44.6%) patients met the diagnostic criteria for severe ARI. Thirty-six (20.6%) patients required invasive mechanical ventilation, and 11 (6.3%) required vasopressor. Ninety-nine (56.6%) patients received oral ribavirin treatment, and 52 (29.7%) received systemic corticosteroids. Forty-one (23.4%) patients had evidence of bacterial infection. Overall mortality was 7.4%. Mortality among patients with non-severe ARI and severe ARI was 1.04% and 15.4%, respectively. Estimated glomerular filtration rate <50 ml/min/1.73 m2 , severe ARI, systemic corticosteroids, and bacterial infection were independently associated with higher risk of mortality. Treatment with oral ribavirin was the only factor associated with reduced mortality (adjusted HR: 0.19, 95% CI: 0.04-0.9, P = 0.03). CONCLUSION: RSV-ARI may result in significant mortality and health care utilization. Treatment with oral ribavirin may improve survival in these patients.