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Current practices for treatment of respiratory syncytial virus and other non-influenza respiratory viruses in high-risk patient populations: a survey of institutions in the Midwestern Respiratory Virus Collaborative.
Transpl Infect Dis. 2016 Apr; 18(2):210-5.TI

Abstract

BACKGROUND

The optimal treatment for respiratory syncytial virus (RSV) infection in adult immunocompromised patients is unknown. We assessed the management of RSV and other non-influenza respiratory viruses in Midwestern transplant centers.

METHODS

A survey assessing strategies for RSV and other non-influenza respiratory viral infections was sent to 13 centers.

RESULTS

Multiplex polymerase chain reaction assay was used for diagnosis in 11/12 centers. Eight of 12 centers used inhaled ribavirin (RBV) in some patient populations. Barriers included cost, safety, lack of evidence, and inconvenience. Six of 12 used intravenous immunoglobulin (IVIG), mostly in combination with RBV. Inhaled RBV was used more than oral, and in the post-stem cell transplant population, patients with lower respiratory tract infection (LRTI), graft-versus-host disease, and more recent transplantation were treated at higher rates. Ten centers had experience with lung transplant patients; all used either oral or inhaled RBV for LRTI, 6/10 treated upper respiratory tract infection (URTI). No center treated non-lung solid organ transplant (SOT) recipients with URTI; 7/11 would use oral or inhaled RBV in the same group with LRTI. Patients with hematologic malignancy without hematopoietic stem cell transplantation were treated with RBV at a similar frequency to non-lung SOT recipients. Three of 12 centers, in severe cases, treated parainfluenza and metapneumovirus, and 1/12 treated coronavirus.

CONCLUSIONS

Treatment of RSV in immunocompromised patients varied greatly. While most centers treat LRTI, treatment of URTI was variable. No consensus was found regarding the use of oral versus inhaled RBV, or the use of IVIG. The presence of such heterogeneity demonstrates the need for further studies defining optimal treatment of RSV in immunocompromised hosts.

Authors+Show Affiliations

Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.Department of Internal Medicine, University of Nebraska, Omaha, Nebraska, USA.Department of Internal Medicine, Northwestern University, Chicago, Illinois, USA.Department of Internal Medicine, Washington University, St. Louis, Missouri, USA.Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA.Department of Internal Medicine, Loyola University Medical Center, Maywood, Illinois, USA.Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan, USA.Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA.Department of Internal Medicine, University of Wisconsin, Madison, Wisconsin, USA.Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA.Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.Department of Internal Medicine, University of Chicago, Chicago, Illinois, USA.Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26923867

Citation

Beaird, O E., et al. "Current Practices for Treatment of Respiratory Syncytial Virus and Other Non-influenza Respiratory Viruses in High-risk Patient Populations: a Survey of Institutions in the Midwestern Respiratory Virus Collaborative." Transplant Infectious Disease : an Official Journal of the Transplantation Society, vol. 18, no. 2, 2016, pp. 210-5.
Beaird OE, Freifeld A, Ison MG, et al. Current practices for treatment of respiratory syncytial virus and other non-influenza respiratory viruses in high-risk patient populations: a survey of institutions in the Midwestern Respiratory Virus Collaborative. Transpl Infect Dis. 2016;18(2):210-5.
Beaird, O. E., Freifeld, A., Ison, M. G., Lawrence, S. J., Theodoropoulos, N., Clark, N. M., Razonable, R. R., Alangaden, G., Miller, R., Smith, J., Young, J. A., Hawkinson, D., Pursell, K., & Kaul, D. R. (2016). Current practices for treatment of respiratory syncytial virus and other non-influenza respiratory viruses in high-risk patient populations: a survey of institutions in the Midwestern Respiratory Virus Collaborative. Transplant Infectious Disease : an Official Journal of the Transplantation Society, 18(2), 210-5. https://doi.org/10.1111/tid.12510
Beaird OE, et al. Current Practices for Treatment of Respiratory Syncytial Virus and Other Non-influenza Respiratory Viruses in High-risk Patient Populations: a Survey of Institutions in the Midwestern Respiratory Virus Collaborative. Transpl Infect Dis. 2016;18(2):210-5. PubMed PMID: 26923867.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Current practices for treatment of respiratory syncytial virus and other non-influenza respiratory viruses in high-risk patient populations: a survey of institutions in the Midwestern Respiratory Virus Collaborative. AU - Beaird,O E, AU - Freifeld,A, AU - Ison,M G, AU - Lawrence,S J, AU - Theodoropoulos,N, AU - Clark,N M, AU - Razonable,R R, AU - Alangaden,G, AU - Miller,R, AU - Smith,J, AU - Young,J A H, AU - Hawkinson,D, AU - Pursell,K, AU - Kaul,D R, Y1 - 2016/03/29/ PY - 2015/07/01/received PY - 2015/09/27/revised PY - 2015/12/08/revised PY - 2015/12/14/accepted PY - 2016/3/1/entrez PY - 2016/3/1/pubmed PY - 2017/1/10/medline KW - IVIG KW - RSV KW - hematopoietic stem cell transplant KW - immunocompromised KW - lung transplant KW - respiratory syncytial virus KW - ribavirin SP - 210 EP - 5 JF - Transplant infectious disease : an official journal of the Transplantation Society JO - Transpl Infect Dis VL - 18 IS - 2 N2 - BACKGROUND: The optimal treatment for respiratory syncytial virus (RSV) infection in adult immunocompromised patients is unknown. We assessed the management of RSV and other non-influenza respiratory viruses in Midwestern transplant centers. METHODS: A survey assessing strategies for RSV and other non-influenza respiratory viral infections was sent to 13 centers. RESULTS: Multiplex polymerase chain reaction assay was used for diagnosis in 11/12 centers. Eight of 12 centers used inhaled ribavirin (RBV) in some patient populations. Barriers included cost, safety, lack of evidence, and inconvenience. Six of 12 used intravenous immunoglobulin (IVIG), mostly in combination with RBV. Inhaled RBV was used more than oral, and in the post-stem cell transplant population, patients with lower respiratory tract infection (LRTI), graft-versus-host disease, and more recent transplantation were treated at higher rates. Ten centers had experience with lung transplant patients; all used either oral or inhaled RBV for LRTI, 6/10 treated upper respiratory tract infection (URTI). No center treated non-lung solid organ transplant (SOT) recipients with URTI; 7/11 would use oral or inhaled RBV in the same group with LRTI. Patients with hematologic malignancy without hematopoietic stem cell transplantation were treated with RBV at a similar frequency to non-lung SOT recipients. Three of 12 centers, in severe cases, treated parainfluenza and metapneumovirus, and 1/12 treated coronavirus. CONCLUSIONS: Treatment of RSV in immunocompromised patients varied greatly. While most centers treat LRTI, treatment of URTI was variable. No consensus was found regarding the use of oral versus inhaled RBV, or the use of IVIG. The presence of such heterogeneity demonstrates the need for further studies defining optimal treatment of RSV in immunocompromised hosts. SN - 1399-3062 UR - https://www.unboundmedicine.com/medline/citation/26923867/Current_practices_for_treatment_of_respiratory_syncytial_virus_and_other_non_influenza_respiratory_viruses_in_high_risk_patient_populations:_a_survey_of_institutions_in_the_Midwestern_Respiratory_Virus_Collaborative_ L2 - https://doi.org/10.1111/tid.12510 DB - PRIME DP - Unbound Medicine ER -