Severe influenza/respiratory syncytial virus infections and hospital antimicrobial stewardship opportunities: impact of a 4-year surveillance including molecular diagnosis.

Bourgeois, Marc;Ausselet, Nathalie;Gerard, Véronique;De Canniere, Louis;Delaere, Bénédicte;et.al.
(2020) Infection Control & Hospital Epidemiology — Vol. 41, n° 10, p. 1184-1189 (2020)

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Abstract
(en) OBJECTIVE: To assess the prevalence of influenza and respiratory syncytial virus (RSV) in adults hospitalized for a respiratory infection in the winter months and to evaluate the impact of a viral diagnosis on empirical antimicrobial management (antibiotics and antivirals). DESIGN: Observational cohort study. SETTING: Acute-care university hospital. PATIENTS: The study included 963 adult patients hospitalized over a 4-year surveillance period. METHODS: Annual surveillance timelines were defined according to epidemiological criteria related to the circulation of RSV and influenza viruses in the general population. Patients were screened following a severe acute respiratory infection (SARI) case definition at the emergency department and were enrolled for molecular assay targeting influenza/RSV viruses after oral informed consent. Epidemiological and clinical data were recorded prospectively, microbiological investigations, antimicrobial management, and outcome data were reviewed retrospectively. RESULTS: An influenza or RSV virus was documented in 316 of 963 patients (33%). Optimization of antimicrobial management (AM) was achieved in 162 of 265 patients (61%) with a positive viral diagnosis and no bacterial infection at admission (AM treatment not initiated, n = 111; discontinued, n = 51). In contrast, only 128 of 462 patients (28%) with negative microbiological investigations did not have AM treatment initiated (n = 116) or had such treatment discontinued (n = 12). Early, targeted antiviral treatment was prescribed in 235 of 253 patients (93%) confirmed with influenza. Epidemiological, clinical, and outcome data were similar in both groups. CONCLUSION: Epidemiological surveillance associated with influenza/RSV molecular diagnosis in adults hospitalized for severe winter respiratory infections dramatically enhanced antimicrobial management.
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Bourgeois, M., Ausselet, N., Gerard, V., De Canniere, L., Scius, N., Michaux, I., Huang, T.-D., Bogaerts, P., Vandamme, C., Bihin, B., & Delaere, B. (2020). Severe influenza/respiratory syncytial virus infections and hospital antimicrobial stewardship opportunities: impact of a 4-year surveillance including molecular diagnosis. Infection Control & Hospital Epidemiology, 41(10), 1184-1189. https://doi.org/10.1017/ice.2020.260 (Original work published 2020)