Program Schedule

Diagnosis and Treatment of Respiratory Syncytial Virus in Immunocompromised Hosts in Large Midwestern Transplant Centers

Session: Poster Abstract Session: Transplant Infectious Diseases
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
  • 429_IDweek.pdf (423.2 kB)
  • Background: Respiratory syncytial virus (RSV) infection results in significant morbidity and mortality in immunocompromised patients. As the optimal management strategy is unknown, practice varies widely between centers.  We sought to assess practice variation in large transplant centers participating in the Midwest Respiratory Virus Consortium (MRVC).

    Methods: A survey assessing center characteristics and treatment strategies was sent to Transplant Infectious Disease (TID) physicians at 13 participating centers.  In addition, information regarding treatment of other non-influenza, non-RSV respiratory viral infections was obtained.

    Results: 11 of 13 centers responded.  Multiplex polymerase chain reaction (PCR) was used for diagnosis in 10/11 centers; one center used rapid antigen testing. 8/11 institutions used inhaled ribavirin (RBV) in at least some patient populations. Reasons cited as barriers against use included cost, safety, lack of supporting evidence, and inconvenience.  8/11 centers used oral RBV and 3 stated a specific preference for oral and 3 a preference for inhaled. 4 of 11 used intravenous immunoglobulin (IVIG), often in combination with RBV.  In the post-stem cell transplant (SCT) population, patients with lower respiratory tract infection (LRTI) were more likely to be treated than those with upper respiratory tract infection (URTI).  Pre-engraftment allo-SCT recipient with URTI would receive RBV in 5/11 centers while LRTI would be treated with RBV in 9/11 centers.  8 centers performed lung transplantation; all used either oral or inhaled RBV for LRTI, 6/8 for URTI.  No center routinely treated non-lung solid organ transplant (SOT) recipients with URTI; 7/11 would consider oral or inh RBV in the same group with LRTI.  Patients with hematologic malignancy but no HSCT were treated with RBV at a similar frequency (1/11 with URTI, 7/11 with LRTI).   2 of 9 centers in severe cases treated parainfluenza, metapneumovirus or coronavirus with IVIG or RBV. 

    Conclusion: Treatment of RSV in immunocompromised patients varied greatly between institutions.  The presence of such heterogeneity demonstrates the need for further studies defining optimal treatment of RSV in immunocompromised hosts.

    Omer Beaird III, MD, University of Michigan, Ann Arbor, MI, Alison Freifeld, MD, Internal Medicine, University of Nebraska Medical Center, Omaha, NE, Michael Ison, MD, Northwestern University, Chicago, IL, Steven Lawrence, MD, MSc, Washington University, St. Louis, MO, Nicole Theodoropoulos, MD, Ohio State University, Columbus, OH, Nina Clark, M.D., Loyola University Medical Center, Maywood, IL, Raymund R. Razonable, MD, Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, George Alangaden, MD, Infectious Diseases, Henry Ford Health System, Detroit, MI, Rachel Miller, MD, University of Iowa Hospitals and Clinics, Iowa City, IA, Jeannina Smith, MD, Infectious Disease, University of Wisconsin, Madison, WI, Jo-Anne Young, MD, University of Minnesota, Minneapolis, MN, Dana Hawkinson, MD, Infectious Diseases, University of Kansas Medical Center, Kansas City, KS and Daniel Kaul, MD, University of Michigan Medical School, Ann Arbor, MI


    O. Beaird III, None

    A. Freifeld, None

    M. Ison, None

    S. Lawrence, None

    N. Theodoropoulos, None

    N. Clark, None

    R. R. Razonable, None

    G. Alangaden, None

    R. Miller, None

    J. Smith, None

    J. A. Young, None

    D. Hawkinson, None

    D. Kaul, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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