Characteristics of community-acquired respiratory viruses infections except seasonal influenza in transplant recipients and non-transplant critically ill patients

Kyoung Hwa Lee, Seul Gi Yoo, Yonggeun Cho, Da Eun Kwon, Yeonju La, Sang Hoon Han, Myoung Soo Kim, Jin Sub Choi, Soon Il Kim, Yu Seun Kim, Yoo Hong Min, June-Won Cheong, Jin Seok Kim, Yong Goo Song, Kyoung Hwa Lee, Seul Gi Yoo, Yonggeun Cho, Da Eun Kwon, Yeonju La, Sang Hoon Han, Myoung Soo Kim, Jin Sub Choi, Soon Il Kim, Yu Seun Kim, Yoo Hong Min, June-Won Cheong, Jin Seok Kim, Yong Goo Song

Abstract

Background/purpose: Transplant recipients are vulnerable to life-threatening community-acquired respiratory viruses (CA-RVs) infection (CA-RVI). Even if non-transplant critically ill patients in intensive care unit (ICU) have serious CA-RVI, comparison between these groups remains unclear. We aimed to evaluate clinical characteristics and mortality of CA-RVI except seasonal influenza A/B in transplant recipients and non-transplant critically ill patients in ICU.

Methods: We collected 37,777 CA-RVs multiplex real-time reverse transcription-polymerase chain reaction test results of individuals aged ≥18 years from November 2012 to November 2017. The CA-RVs tests included adenovirus, coronavirus 229E/NL63/OC43, human bocavirus, human metapneumovirus, parainfluenza virus 1/2/3, rhinovirus, and respiratory syncytial virus A/B.

Results: We found 286 CA-RVI cases, including 85 solid organ transplantation recipients (G1), 61 hematopoietic stem cell transplantation recipients (G2), and 140 non-transplant critically ill patients in ICU (G3), excluding those with repeated isolation within 30 days. Adenovirus positive rate and infection cases were most prominent in G2 (p < 0.001). The median time interval between transplantation and CA-RVI was 30 and 20 months in G1 and G2, respectively. All-cause in-hospital mortality was significantly higher in G3 than in G1 or G2 (51.4% vs. 28.2% or 39.3%, p = 0.002, respectively). The mechanical ventilation (MV) was the independent risk factor associated with all-cause in-hospital mortality in all three groups (hazard ratio, 3.37, 95% confidence interval, 2.04-5.56, p < 0.001).

Conclusions: This study highlights the importance of CA-RVs diagnosis in transplant recipients even in long-term posttransplant period, and in non-transplant critically ill patients in ICU with MV.

Keywords: Community-acquired respiratory viruses; Critically ill patients; Hematopoietic stem cell transplantation; Mortality; Solid organ transplantation.

Copyright © 2019. Published by Elsevier B.V.

Figures

Figure 1
Figure 1
Flow chart of data or case selection for community-acquired respiratory viruses infection except seasonal influenza A/B, aThe CA-RVs tests included the multiplex RT-PCR or culture, but not antigen or serology tests. bThe 12 CA-RVs includes adenovirus, coronavirus 229E/NL63/OC43, human bocavirus, human metapneumovirus, parainfluenza virus 1/2/3, rhinovirus and respiratory syncytial virus A/B. cSOT, HSCT recipients and non-transplant critically ill patients in ICU. dAll recipients had received SOT after HSCT (1 liver and 10 lung transplantations). eIn 286 tests, 5 (1.7%) positive results were 1 of coronavirus OC43, 3 of parainfluenza virus and 1 of rhinovirus. fThe repeated identical CA-RV isolation in one patient within 30 days were considered as same infection case. All RV cultures were negative, and positive results of CA-RVs were confirmed by multiplex RT-PCR. Abbreviations: CA-RV, community-acquired respiratory virus; CA-RVI, community-acquired respiratory virus infection; HSCT, hematopoietic stem cell transplantation; ICU, intensive care unit; RT-PCR, reverse transcription-polymerase chain reaction; SOT, solid organ transplantation.
Figure 2
Figure 2
Time intervals between transplantation and community-acquired respiratory virusesa infection except seasonal influenza A/B in SOT and HSCT recipients, aInclude adenovirus, coronavirus 229E/NL63/OC43, human bocavirus, human metapneumovirus, parainfluenza virus 1/2/3, rhinovirus and respiratory syncytial virus A/B. The middle long and upper/lower bars indicate median and upper/lower interquartile values, respectively. Abbreviations: CA-RVI, community-acquired respiratory virus infection; HSCT, hematopoietic stem cell transplantation; SOT, solid organ transplantation; Tx, transplantation.
Figure 3
Figure 3
The comparison of all cause in-hospital mortality between SOT recipients, HSCT recipients and non-transplant critically ill patients in ICU with community-acquired respiratory virusesa infection except seasonal influenza A/B, ∗Log rank test (Mantel-Cox). aInclude adenovirus, coronavirus 229E/NL63/OC43, human bocavirus, human metapneumovirus, parainfluenza virus 1/2/3, rhinovirus and respiratory syncytial virus A/B. Aberrations: CA-RV, community-acquired respiratory virus; HSCT, hematopoietic stem cell transplantation; ICU, intensive care unit; SOT, solid organ transplantation.

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