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. 2020 Mar;80(3):333-341.
doi: 10.1016/j.jinf.2019.12.022. Epub 2020 Jan 20.

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

JoséLuis Piñana  1 , Juan Montoro  2 , Carla Aznar  3 , Ignacio Lorenzo  2 , María Dolores Gómez  4 , Manuel Guerreiro  2 , Carlos Carretero  2 , Eva María González-Barberá  4 , Aitana Balaguer-Roselló  2 , Rosa Sanz  3 , Miguel Salavert  5 , David Navarro  6 , Miguel A Sanz  7 , Guillermo Sanz  7 , Jaime Sanz  7
Affiliations

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

JoséLuis Piñana et al. J Infect. 2020 Mar.

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.

Keywords: Allogeneic hematopoietic stem cell transplantation; Community-acquired respiratory virus; Immunodeficiency score index; Influenza; Parainfluenza virus; Prospective respiratory virus surveillance program; Respiratory syncytial virus; Respiratory virus infection.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1
Fig. 1
(A) Three-month overall survival according to the community acquired respiratory virus (CARV) infection period (96% in the prospective cohort vs. 78% in the standard clinical practice cohort, p < 0.0001); (B) Three-month overall survival in recipients with CARV LRTD according to the CARV infection period (94% in the prospective cohort vs. 63% in the standard clinical practice cohort, p < 0.0001).
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