Epidemiology and Characteristics of Respiratory Syncytial Virus Pneumonia in Critically Ill Adults

Taeeun Kim; Jin Won Huh; Sang-Bum Hong; Jiwon Jung; Min Jae Kim; Yong Pil Chong; Heungsup Sung; Kyung Hyun Doh; Sung-Han Kim; Sang-Oh Lee; Yang Soo Kim; Chae-Man Lim; Younsuck Koh; Sang-Ho Choi

doi:10.1093/ofid/ofad131

Epidemiology and Characteristics of Respiratory Syncytial Virus Pneumonia in Critically Ill Adults

Open Forum Infect Dis. 2023 Mar 10;10(4):ofad131. doi: 10.1093/ofid/ofad131. eCollection 2023 Apr.

Authors

Affiliations

¹ Division of Infectious Diseases, Department of Medicine, Nowon Eulji University Hospital, Seoul 01830, Republic of Korea.
² Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
³ Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
⁴ Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
⁵ Department of Radiology and the Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Abstract

Background: Severe respiratory syncytial virus (RSV)-associated pneumonia in adults has rarely been addressed. We investigated the burden and clinical characteristics of severe RSV-associated pneumonia in critically ill adult patients.

Methods: We analyzed a prospective cohort of 2865 adults with severe pneumonia who were admitted to the intensive care unit in a 2700-bed tertiary care hospital from 2010 to 2019. The epidemiology, characteristics, and outcomes of 92 cases of severe RSV-associated pneumonia and 163 cases of severe influenza virus (IFV)-associated pneumonia were compared.

Results: Of 1589 cases of severe community-acquired pneumonia, the incidence of RSV-associated pneumonia was less than half that of IFV-associated pneumonia (3.4% vs 8.1%). However, among 1276 cases of severe hospital-acquired pneumonia (HAP), there were slightly more cases of RSV-associated than IFV-associated pneumonia (3.8% vs 3.5%). During the 9 epidemic seasons, RSV-A (5 seasons) and RSV-B (4 seasons) predominated alternately. Structural lung disease, diabetes mellitus, and malignancy were common underlying diseases in both groups. Immunocompromise (57.6% vs 34.4%; P < .001) and hospital acquisition (47.8% vs 23.9%; P < .001) were significantly more common in the RSV group. Coinfection with Streptococcus pneumoniae (3.3% vs 9.8%; P = .08) and methicillin-susceptible Staphylococcus aureus (1.1% vs 6.8%; P = .06) tended to be less frequent in the RSV group. The 90-day mortality was high in both groups (39.1% vs 40.5%; P = .89).

Conclusions: RSV infection was associated with substantial morbidity and mortality in critically ill adult patients, similar to IFV. The relatively higher incidence of RSV in severe HAP suggests that the transmissibility of RSV can exceed that of IFV in a hospital setting.

Keywords: hospital-acquired pneumonia; influenza; intensive care unit; respiratory syncytial virus; severe adult pneumonia.