Abstract
Background
Respiratory syncytial virus (RSV) causes acute respiratory illness (ARI) and triggers exacerbations of cardiopulmonary disease. Estimates of incidence in hospitalized adults range ...widely, with few data on incidence in adults with comorbidities that increase the risk of severity. We conducted a prospective, population-based, surveillance study to estimate incidence of RSV hospitalization among adults overall and those with specific comorbidities.
Methods
Hospitalized adults aged ≥18 years residing in the surveillance area with ≥2 ARI symptoms or exacerbation of underlying cardiopulmonary disease were screened during the 2017–2018, 2018–2019, and 2019–2020 RSV seasons in 3 hospitals in Rochester, New York and New York City. Respiratory specimens were tested for RSV using polymerase chain reaction assays. RSV incidence per 100 000 was adjusted by market share.
Results
Active and passive surveillance identified 1099 adults hospitalized with RSV. Annual incidence during 3 seasons ranged from 44.2 to 58.9/100 000. Age-group–specific incidence ranged from 7.7 to 11.9/100 000, 33.5 to 57.5/100 000, and 136.9 to 255.6/100 000 in patients ages 18–49, 50–64, and ≥65 years, respectively. Incidence rates in patients with chronic obstructive pulmonary disease, coronary artery disease, and congestive heart failure were 3–13, 4–7, and 4–33 times, respectively, the incidence in patients without these conditions.
Conclusions
We found a high burden of RSV hospitalization in this large prospective study. Notable was the high incidence among older patients and those with cardiac conditions. These data confirm the need for effective vaccines to prevent RSV infection in older and vulnerable adults.
We found a high burden of respiratory syncytial virus (RSV) in this prospective study of hospitalized adults over 3 winters. Population-based estimates confirm highest incidence among older patients and those with cardiac conditions. These data confirm the need for effective RSV vaccines.
Background
Although the burden of influenza is well characterized, the burden of community‐onset non‐influenza respiratory viruses has not been systematically assessed. Understanding the severity and ...seasonality of non‐influenza viruses, including human coronaviruses, will provide a better understanding of the overall disease burden from respiratory viruses that could better inform resource utilization for hospitals and highlight the value of preventative strategies, including vaccines.
Methods
From October 2017 to September 2019, a retrospective study was performed in a pre‐defined catchment area to estimate the population‐based incidence of community‐onset respiratory viruses associated with hospitalization. Included patients were ≥18 years old, resided in New York City, were hospitalized for ≥24 hours, and had a respiratory virus detected within 3 calendar‐days of admission. Disease burden was measured by hospital length of stay (LOS), intensive care unit (ICU) admissions, and in‐hospital mortality and compared among those with laboratory‐confirmed influenza versus those with laboratory‐confirmed non‐influenza viruses (human coronaviruses, parainfluenza viruses, respiratory syncytial virus, human metapneumovirus, and adenovirus).
Results
During the study period, 4232 eligible patients were identified of whom 50.9% were ≥65 years of age. For each virus, the population‐based incidence was highest for those ≥80 years of age. When compared to those with influenza viruses detected, those with non‐influenza respiratory viruses detected (combined) had higher population‐based incidence, significantly more ICU admissions, and higher in‐house mortality.
Conclusions
The burden of non‐influenza respiratory viruses for hospitalized adults is substantial. Prevention and treatment strategies are needed for non‐influenza respiratory viruses, particularly for older adults.
Background
Respiratory syncytial virus (RSV) infections are common in adults, but data describing the cost of RSV‐associated hospitalization are lacking due to inconsistency in diagnostic coding and ...incomplete case ascertainment. We evaluated costs of RSV‐associated hospitalization in adult patients with laboratory‐confirmed, community‐onset RSV.
Methods
We included adults ≥ 18 years of age admitted to three hospital systems in New York during two RSV seasons who were RSV‐positive by polymerase chain reaction (PCR) and had more than or equal to two acute respiratory infection symptoms or exacerbation of underlying cardiopulmonary disease. We ed costs from hospital finance systems or converted hospital charges to cost using cost‐charge ratios. We converted cost into 2020 US dollars and extrapolated to the United States. We used a generalized linear model to determine predictors of hospitalization cost, stratified by admission to intensive care units (ICU).
Results
Cost data were available for 79% (601/756) of eligible patients. The mean total cost of hospitalization was $8403 (CI95 $7240–$9741). The highest costs were those attributed to ICU services $7885 (CI95 $5877–$10,240), whereas the lowest were radiology $324 (CI95 $275–$376). Other than longer length of stay, predictors of higher cost included having chronic liver disease (odds ratio OR 1.38 CI95 1.05–1.80) for patients without ICU admission and antibiotic use (OR 1.49 CI95 1.10–2.03) for patients with ICU admission. The annual US cost was estimated to be $1.2 (CI95 0.9–1.4) billion.
Conclusion
The economic burden of RSV hospitalization of adults ≥ 18 years of age in the United States is substantial. RSV vaccine programs may be useful in reducing this economic burden.
Objectives
Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in older adults. We assessed severe clinical outcomes among hospitalized adults that were associated with RSV ...infections.
Methods
We performed a nested retrospective study in 3 New York City hospitals during 2 respiratory viral seasons, October 2017–April 2018 and October 2018–April 2019, to determine the proportion of patients with laboratory-confirmed RSV infection who experienced severe outcomes defined as intensive care unit (ICU) admission, mechanical ventilation, and/or death. We assessed factors associated with these severe outcomes and explored the effect of RSV-associated hospitalizations on changes in the living situations of surviving patients.
Results
Of the 403 patients studied (median age, 69 years), 119 (29.5%) were aged ≥80. Severe outcomes occurred in 19.1% of patients, including ICU admissions (16.4%), mechanical ventilation (12.4%), and/or death (6.7%). Patients admitted from residential living facilities had a 4.43 times higher likelihood of severe RSV infection compared with patients who were living in the community with or without assistance from family or home health aides. At discharge, 56 (15.1%) patients required a higher level of care than at admission.
Conclusions
RSV infection was associated with severe outcomes in adults. Living in a residential facility at admission was a risk factor for severe outcomes and could be a proxy for frailty rather than an independent risk factor. Our data support the development of prevention strategies for RSV infection in older populations, especially older adults living in residential living facilities.
Abstract
Background
Outpatient parenteral antimicrobial therapy (OPAT) is a mechanism for delivery of antimicrobial therapy over a prolonged period in an environment outside of inpatient care. ...Benefits of OPAT include avoidance of hospital stays, prevention of hospital-associated conditions, and significant cost savings. We analyzed the frequency of all-cause 90-day emergency department (ED) visits, readmissions, and mortality of patients pre- and post-implementation of OPAT plan reconciliation in June of 2020.
Methods
Unique, adult OPAT recipients discharged to home or post-acute care facilities from an academic hospital between 6/2017 and 6/2022 were included in our cohort. On 6/14/2020, a program was launched that entailed OPAT plan review and reconciliation by infectious diseases (ID) pharmacists prior to OPAT recipients discharging from acute care; all participants discharged on or after this date were included in the post-intervention cohort. (Figure 1) Data on patient characteristics, admission events, and outcomes were collected from the electronic medical record. We performed a propensity score weighted analysis with pre-defined variables to determine which demonstrate an association with our outcomes. We accounted for missing data by using multiple imputation.
Results
2408 OPAT patients meeting inclusion criteria were identified: 1650 pre-implementation and 758 post-implementation. (Table 1) Variables for which the standard mean difference between groups was ≥ 0.1 include race, chronic kidney disease, length of stay, ID consultation, and payor. (Figure 2) In our propensity-weighted analysis, there was a statistically significant difference between the proportion of patients in the pre- and post-implementation groups that presented to the ED (pre- 22.3%; post- 17.9%; p=0.032) or were readmitted (pre- 39.1%; post- 33.1%; p=0.008) within 90 days after discharge from index admission. (Table 2) There was no significant difference in the 90-day all-cause mortality between the pre- and post-implementation cohorts.
Conclusion
Following institution of OPAT plan reconciliation by ID pharmacists prior to discharge from acute care, OPAT recipients were significantly less likely to experience 90-day ED visits or 90-day readmissions.
Disclosures
Elizabeth B. Hirsch, PharmD, Melinta Therapuetics: Honoraria|Merck and Company, Inc.: Grant/Research Support
One of the factors that contributes to the pathogenesis of acne is Propionibacterium acnes; yet, the molecular mechanism by which P. acnes induces inflammation is not known. Recent studies have ...demonstrated that microbial agents trigger cytokine responses via Toll-like receptors (TLRs). We investigated whether TLR2 mediates P. acnes-induced cytokine production in acne. Transfection of TLR2 into a nonresponsive cell line was sufficient for NF-kappa B activation in response to P. acnes. In addition, peritoneal macrophages from wild-type, TLR6 knockout, and TLR1 knockout mice, but not TLR2 knockout mice, produced IL-6 in response to P. acnes. P. acnes also induced activation of IL-12 p40 promoter activity via TLR2. Furthermore, P. acnes induced IL-12 and IL-8 protein production by primary human monocytes and this cytokine production was inhibited by anti-TLR2 blocking Ab. Finally, in acne lesions, TLR2 was expressed on the cell surface of macrophages surrounding pilosebaceous follicles. These data suggest that P. acnes triggers inflammatory cytokine responses in acne by activation of TLR2. As such, TLR2 may provide a novel target for treatment of this common skin disease.
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