Recent advances in viral detection assays have allowed better identification of community respiratory virus (CRV) infections. Literature comparing the morbidity and mortality of CRVs within the same population is limited. We have studied the clinical manifestations of these pathogens in patients admitted to a single academic medical center.
We retrospectively reviewed charts of 1520 patients admitted between January 2010 and December 2013 with CRV infections. Patients tested positive either by rapid influenza antigen test for influenza A and B viral antigens or by a multiplex nucleic acid amplification test that detects 12 viruses in respiratory specimens; adenovirus, rhinovirus, influenza A and H1 and H3 subtypes, influenza B, respiratory syncytial virus (RSV) α and β, human metapneumovirus (hMPV) and parainfluenza viruses 1 to 3. Data was collected regarding mortality, length of hospital stay, need for and length of ICU stay, need for and days of mechanical ventilation. Statistical analyses were performed using Fisher's Exact, Pearson's Chi-Square, and Kruskal-Wallis tests.
There were 1427 admissions with a single CRV infection, and 166 admissions with two or more concurrent CRVs. There was a significant association between age group and CRV identified. RSV was the predominant pathogen in children ≤ 4 years of age, and influenza in older patients (p<.001) (figure 1). The relative percentage of patients admitted to an ICU varied between viruses, with the highest relative percentage of ICU admissions seen with rhinovirus and hMPV, 43.7% and 35.9% respectively (P < 0.001). In patients older than 65 years of age there was also a significant difference between the CRVs in the relative rate of mechanical ventilation (p<.001) where rhinovirus and hMPV again had the highest rates, 20% and 15.4% respectively. There were no clinically significant differences between the CRVs in lengths of stay or all-cause mortality.
Influenza and RSV were the predominant CRVs seen in hospitalized patients. Although less commonly identified, patients older than 5 years of age hospitalized with rhinovirus or hMPV infection had a higher frequency of ICU admission and for those over 65 years of age, a more frequent need for mechanical ventilation.
Figure (1) Admissions with CRV infections stratified by age
S. Tacvorian, None
S. Stock, None
R. Ellison III, None