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

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.

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

Time intervals between transplantation and community-acquired respiratory viruses^a 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

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 viruses^a 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.