title: Adult patients with respiratory syncytial virus infection: impact of solid organ and hematopoietic stem cell transplantation on outcomes.
abstract: BACKGROUND
  Respiratory syncytial virus (RSV) is a common community-acquired pathogen responsible for a substantial disease burden in adults. We investigated the outcomes after RSV infection in hospitalized adults over a 3-year period.
  
  
  METHODS
  This single-center, retrospective study identified 174 patients hospitalized with RSV upper or lower respiratory tract infection (LRTI) between January 1, 2009 and June 30, 2012. Clinical data were extracted from medical records. The primary outcome analyzed was all-cause mortality, defined as death during the index hospital admission. Subjects were divided into 3 groups for comparison: hematopoietic stem cell transplant (HSCT) patients, solid organ transplant (SOT) patients, and non-transplant patients.
  
  
  RESULTS
  In our study, 41/174 (23.6%) were HSCT recipients and 28/174 (16.1%) were SOT recipients. Twelve of 174 (6.9%) died. Death occurred in 2/41 (4.9%) HSCT and 3/28 (10.7%) SOT recipients, compared to 7/106 (6.6%) non-transplant patients. When compared to the non-transplant cohort, HSCT and SOT were not found to be significant risk factors for mortality (P = 0.685 and 0.645, respectively). In multivariate logistic regression, age >60 was associated with mortality (P = 0.019), while lymphopenia on admission trended toward an association with death (P = 0.054). HSCT patients were less likely to be admitted to an intensive care unit (odds ratio [OR] 0.26, P = 0.04), but were significantly more likely to receive ribavirin therapy (OR 11.62, P < 0.0001).
  
  
  CONCLUSIONS
  Adults hospitalized with RSV LRTI are at significant risk of mortality, and this risk may be increased in patients age >60 or with lymphopenia on admission. This study did not identify any significant increased mortality or morbidity associated with RSV infection in immune suppressed transplant recipients vs. patients who had not received a transplant.
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: P
authors.initials: P
authors.lastname: Pilie
authors.affiliation: Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: W A
authors.initials: WA
authors.lastname: Werbel
authors.affiliation: Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: J
authors.initials: J
authors.lastname: Riddell
authors.affiliation: Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: X
authors.initials: X
authors.lastname: Shu
authors.affiliation: Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: D
authors.initials: D
authors.lastname: Schaubel
authors.affiliation: Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: K S
authors.initials: KS
authors.lastname: Gregg
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality; D018357:Respiratory Syncytial Virus Infections / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors
keywords: respiratory syncytial virus; ribavirin; transplantation