Clinical characteristics and outcomes of respiratory syncytial virus-associated ARF in immunocompetent patients: A seven-year experience at a tertiary hospital in France

David Mokrani; Quentin Le Hingrat; Michaël Thy; Christophe Choquet; Véronique Joly; Sylvie Lariven; Christophe Rioux; Laurène Deconinck; Paul Loubet; Thomas Papo; Bruno Crestani; Vincent Bunel; Lila Bouadma; Antoine Khalil; Laurence Armand-Lefèvre; Agathe Raynaud-Simon; Jean-François Timsit; François-Xavier Lescure; Yazdan Yazdanpanah; Diane Descamps; Nathan Peiffer-Smadja

doi:10.1016/j.jinf.2024.106180

Clinical characteristics and outcomes of respiratory syncytial virus-associated ARF in immunocompetent patients: A seven-year experience at a tertiary hospital in France

J Infect. 2024 May 15;89(1):106180. doi: 10.1016/j.jinf.2024.106180. Online ahead of print.

Authors

David Mokrani¹, Quentin Le Hingrat², Michaël Thy³, Christophe Choquet⁴, Véronique Joly⁵, Sylvie Lariven¹, Christophe Rioux¹, Laurène Deconinck¹, Paul Loubet⁶, Thomas Papo⁷, Bruno Crestani⁸, Vincent Bunel⁹, Lila Bouadma¹⁰, Antoine Khalil¹¹, Laurence Armand-Lefèvre¹², Agathe Raynaud-Simon¹³, Jean-François Timsit¹⁰, François-Xavier Lescure⁵, Yazdan Yazdanpanah⁵, Diane Descamps², Nathan Peiffer-Smadja¹⁴

Affiliations

¹ Infectious and Tropical Diseases Department, Bichat - Claude Bernard Hospital, AP-HP Nord-Université Paris Cité, Paris, France.
² IAME INSERM UMR 1137, Université Paris Cité, Paris, France; Department of Virology, Bichat - Claude Bernard Hospital, AP-HP Nord-Université Paris Cité, Paris, France.
³ IAME INSERM UMR 1137, Université Paris Cité, Paris, France; Medical and Infectious Diseases ICU, Bichat - Claude Bernard Hospital, AP-HP Nord-Université, Paris, France; EA7323, Pharmacology and Drug Evaluation in Children and Pregnant Women, Université Paris Cité, Paris, France.
⁴ Emergency Department, Bichat - Claude Bernard Hospital, AP-HP Nord-Université Paris Cité, Paris, France.
⁵ Infectious and Tropical Diseases Department, Bichat - Claude Bernard Hospital, AP-HP Nord-Université Paris Cité, Paris, France; IAME INSERM UMR 1137, Université Paris Cité, Paris, France.
⁶ Department of Infectious and Tropical Diseases, CHU Nîmes, Université de Montpellier, Nîmes, France; VBIC INSERM U1047, Université de Montpellier, Nîmes, France.
⁷ Department of Internal Medicine, Bichat - Claude Bernard Hospital, AP-HP Nord-Université Paris Cité, Paris, France.
⁸ Department of Pulmonology A, Bichat - Claude Bernard Hospital, AP-HP Nord-Université Paris Cité, Paris, France; INSERM UMR 1152 PHERE, Université Paris Cité, Paris, France.
⁹ INSERM UMR 1152 PHERE, Université Paris Cité, Paris, France; Department of Pulmonology B and Lung Transplantation, Claude - Bernard Hospital, APHP Nord-Université Paris Cité, Paris, France.
¹⁰ IAME INSERM UMR 1137, Université Paris Cité, Paris, France; Medical and Infectious Diseases ICU, Bichat - Claude Bernard Hospital, AP-HP Nord-Université, Paris, France.
¹¹ Department of Radiology, Bichat - Claude Bernard Hospital, AP-HP Nord-Université Paris Cité, Paris, France.
¹² IAME INSERM UMR 1137, Université Paris Cité, Paris, France; Department of Bacteriology, Bichat - Claude Bernard Hospital, AP-HP Nord-Université Paris Cité, Paris, France.
¹³ Department of Geriatrics, Bichat - Claude Bernard, Beaujon and Bretonneau Hospitals, AP-HP Nord-Université Paris Cité, Paris, France.
¹⁴ Infectious and Tropical Diseases Department, Bichat - Claude Bernard Hospital, AP-HP Nord-Université Paris Cité, Paris, France; IAME INSERM UMR 1137, Université Paris Cité, Paris, France. Electronic address: nathan.psmadja@gmail.com.

PMID: 38759759
DOI: 10.1016/j.jinf.2024.106180

Abstract

Background: Respiratory syncytial virus (RSV) is widely recognized as a cause of acute respiratory failure in infants and immunocompromised patients. However, RSV can also contribute to acute respiratory failure in adults, particularly among the elderly population. The objective of this study was to analyze the clinical characteristics and outcomes of immunocompetent adults hospitalized for RSV infection.

Methods: This retrospective study included all immunocompetent adult patients consecutively admitted to a tertiary care hospital with RSV-related acute respiratory failure over a seven-year period (2016-2023). Diagnosis of RSV infection was made through nasal swabs or pulmonary samples, with multiplex reverse transcription polymerase chain reaction (RT-PCR). Patients were eligible for inclusion if they required supplemental oxygen therapy for at least 48 h.

Results: One hundred and four patients met the inclusion criteria. Median age [IQR] was 77 years [67-85]. Ninety-seven patients had at least one comorbidity (97/104, 93%). At the time of RSV diagnosis, 67 patients (67/104, 64%) experienced acute decompensation of a pre-existing chronic comorbidity. Antibiotics were started in 80% (77/104) of patients; however, only 16 patients had a confirmed diagnosis of bacterial superinfection. Twenty-six patients needed ventilatory support (26/104, 25%) and 21 were admitted to the intensive care unit (21/104, 20%). The median duration of oxygen therapy [IQR] was 6 days [3-9], while the median hospital length of stay [IQR] was 11 days [6-15]. The overall mortality rate within 1 month of hospital admission was 13% (14/104). The sole variables associated with one-month mortality were age and maximum oxygen flow during hospitalization.

Conclusion: RSV-associated acute respiratory failure affected elderly individuals with multiple comorbidities and was associated with prolonged hospitalization and a high mortality rate.

Keywords: Lower respiratory tract infection; Pneumonia; RSV; Respiratory syncytial virus; Respiratory virus.