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The clinical benefit of instituting a prospective clinical community-acquired respiratory virus surveillance program in allogeneic hematopoietic stem cell transplantation.
J Infect 2020JI

Abstract

BACKGROUND

There is a lack of studies comparing clinical outcomes among retrospective versus prospective cohorts of allogeneic stem cell transplant (allo-HCT) recipients with community acquired respiratory virus (CARV) infections.

METHODS

We compare outcomes in two consecutive cohorts of allo-HCT recipients with CARV infections. The retrospective cohort included 63 allo-HCT recipients with 108 CARV infections from January 2013 to April 2016 who were screened and managed following standard clinical practice based on influenza and respiratory syncytial virus rapid antigen detection methods. The prospective cohort was comprised of 144 consecutive recipients with 297 CARV episodes included in a prospective interventional clinical surveillance program (ProClinCarvSur-P) based on syndromic multiplex PCR as first-line test from May 2016 to December 2018 at a single transplant center.

RESULTS

CARV infections in the retrospective cohort showed more severe clinical features at the time of diagnosis compared to the prospective cohort (fever 83% vs 57%, hospital admission 69% vs 28% and lower respiratory tract 58% vs 31%, respectively, p ≤ 0.002 for all comparisons). Antiviral therapy was more commonly prescribed in the prospective cohort (69 vs 43 treated CARV episodes), particularly at the upper respiratory tract disease stage (34 vs 12 treated CARV episodes). Three-month all-cause mortality was significantly higher in the retrospective cohort (n= 23, 37% vs n= 10, 7%, p< 0.0001). Multivariate logistic regression analysis showed that recipients included in ProClinCarvSur-P had lower mortality rate [odds ratio 0.31, 95% confidence interval 0.12-0.7, p= 0.01].

CONCLUSION

This study report on outcome differences when reporting retrospective vs prospective CARV infections after allo-HCT. Recipients included in a ProClinCarvSur-P had lower mortality.

Authors+Show Affiliations

Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain. Electronic address: jlpinana@gmail.com.Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.Outpatient hematology/Oncology nursing unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain.Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.Microbiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.Microbiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.Outpatient hematology/Oncology nursing unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain.Department of Infectious Diseases, Hospital Universitari i Politècnic La Fe, Valencia, Spain.Microbiology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain; Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain.Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain; Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain.Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain; Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain.Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain; Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31972212

Citation

Piñana, JoséLuis, et al. "The Clinical Benefit of Instituting a Prospective Clinical Community-acquired Respiratory Virus Surveillance Program in Allogeneic Hematopoietic Stem Cell Transplantation." The Journal of Infection, 2020.
Piñana J, Montoro J, Aznar C, et al. The clinical benefit of instituting a prospective clinical community-acquired respiratory virus surveillance program in allogeneic hematopoietic stem cell transplantation. J Infect. 2020.
Piñana, J., Montoro, J., Aznar, C., Lorenzo, I., Gómez, M., Guerreiro, M., ... Sanz, J. (2020). The clinical benefit of instituting a prospective clinical community-acquired respiratory virus surveillance program in allogeneic hematopoietic stem cell transplantation. The Journal of Infection, doi:10.1016/j.jinf.2019.12.022.
Piñana J, et al. The Clinical Benefit of Instituting a Prospective Clinical Community-acquired Respiratory Virus Surveillance Program in Allogeneic Hematopoietic Stem Cell Transplantation. J Infect. 2020 Jan 20; PubMed PMID: 31972212.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The clinical benefit of instituting a prospective clinical community-acquired respiratory virus surveillance program in allogeneic hematopoietic stem cell transplantation. AU - Piñana,JoséLuis, AU - Montoro,Juan, AU - Aznar,Carla, AU - Lorenzo,Ignacio, AU - Gómez,MaríaDolores, AU - Guerreiro,Manuel, AU - Carretero,Carlos, AU - González-Barberá,EvaMaría, AU - Balaguer-Roselló,Aitana, AU - Sanz,Rosa, AU - Salavert,Miguel, AU - Navarro,David, AU - Sanz,MiguelA, AU - Sanz,Guillermo, AU - Sanz,Jaime, Y1 - 2020/01/20/ PY - 2019/09/25/received PY - 2019/11/11/revised PY - 2019/12/05/accepted PY - 2020/1/24/entrez PY - 2020/1/24/pubmed PY - 2020/1/24/medline KW - Community-acquired respiratory virus, allogeneic hematopoietic stem cell transplantation KW - Immunodeficiency score index KW - Influenza KW - Parainfluenza virus KW - Prospective respiratory virus surveillance program KW - Respiratory syncytial virus KW - Respiratory virus infection JF - The Journal of infection JO - J. Infect. N2 - BACKGROUND: There is a lack of studies comparing clinical outcomes among retrospective versus prospective cohorts of allogeneic stem cell transplant (allo-HCT) recipients with community acquired respiratory virus (CARV) infections. METHODS: We compare outcomes in two consecutive cohorts of allo-HCT recipients with CARV infections. The retrospective cohort included 63 allo-HCT recipients with 108 CARV infections from January 2013 to April 2016 who were screened and managed following standard clinical practice based on influenza and respiratory syncytial virus rapid antigen detection methods. The prospective cohort was comprised of 144 consecutive recipients with 297 CARV episodes included in a prospective interventional clinical surveillance program (ProClinCarvSur-P) based on syndromic multiplex PCR as first-line test from May 2016 to December 2018 at a single transplant center. RESULTS: CARV infections in the retrospective cohort showed more severe clinical features at the time of diagnosis compared to the prospective cohort (fever 83% vs 57%, hospital admission 69% vs 28% and lower respiratory tract 58% vs 31%, respectively, p ≤ 0.002 for all comparisons). Antiviral therapy was more commonly prescribed in the prospective cohort (69 vs 43 treated CARV episodes), particularly at the upper respiratory tract disease stage (34 vs 12 treated CARV episodes). Three-month all-cause mortality was significantly higher in the retrospective cohort (n= 23, 37% vs n= 10, 7%, p< 0.0001). Multivariate logistic regression analysis showed that recipients included in ProClinCarvSur-P had lower mortality rate [odds ratio 0.31, 95% confidence interval 0.12-0.7, p= 0.01]. CONCLUSION: This study report on outcome differences when reporting retrospective vs prospective CARV infections after allo-HCT. Recipients included in a ProClinCarvSur-P had lower mortality. SN - 1532-2742 UR - https://www.unboundmedicine.com/medline/citation/31972212/The_clinical_benefit_of_instituting_a_prospective_clinical_community-acquired_respiratory_virus_surveillance_program_in_allogeneic_hematopoietic_stem_cell_transplantation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0163-4453(20)30024-4 DB - PRIME DP - Unbound Medicine ER -