Outcomes Related to Bacterial Co-Infection and Antibiotic Use in Adults Hospitalized With Respiratory Syncytial Virus Compared with Influenza - Scorecard - MDSpire
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Outcomes Related to Bacterial Co-Infection and Antibiotic Use in Adults Hospitalized With Respiratory Syncytial Virus Compared with Influenza
Clinical Scorecard: Clinical Outcomes of Bacterial Co-Infections and Antibiotic Administration in Adults Admitted for Respiratory Syncytial Virus Versus Influenza
At a Glance
Category
Detail
Condition
Respiratory Syncytial Virus (RSV) and Influenza A or B infections in hospitalized adults
Key Mechanisms
Bacterial co-infections and antibiotic use impact on mortality, length of stay, and respiratory support requirements
Target Population
Adults hospitalized with laboratory-confirmed RSV, influenza A, or influenza B
Care Setting
Tertiary care hospitals
Key Highlights
Bacterial co-infections occurred in approximately one-quarter of patients with RSV, influenza A, and influenza B.
Among RSV patients, bacterial co-infection was not associated with increased mortality, need for high-flow oxygen, mechanical ventilation, or longer hospital stay.
Early antibiotic treatment was common even without bacterial co-infection but was associated with prolonged length of stay and did not improve survival.
Guideline-Based Recommendations
Diagnosis
Perform microbiological testing within 48 hours of admission including lower respiratory tract cultures, PCR for atypical bacteria, and urinary antigen tests to identify bacterial co-infections.
Use chest imaging combined with respiratory symptoms to diagnose pneumonia.
Management
Antibiotic treatment should be considered carefully as early antibiotic use in RSV patients without bacterial co-infection does not improve survival.
Monitor for bacterial co-infections but recognize that their presence in RSV patients may not worsen clinical outcomes.
Monitoring & Follow-up
Monitor clinical outcomes including mortality at 14, 30, and 90 days, length of hospital stay, and need for respiratory support such as high-flow oxygen or mechanical ventilation.
Risks
Unnecessary antibiotic use may prolong hospital stay without survival benefit in RSV patients without bacterial co-infection.
Patient & Prescribing Data
Adults hospitalized with RSV, influenza A, or influenza B, median age 74 years, majority with comorbidities
Antibiotics were frequently administered within 48 hours even in absence of bacterial co-infection; however, early antibiotic therapy did not improve mortality outcomes and was linked to longer hospitalization.
Clinical Best Practices
Limit antibiotic use to patients with confirmed or strongly suspected bacterial co-infections to avoid unnecessary treatment.
Employ comprehensive microbiological testing early in admission to guide antibiotic stewardship.
Consider patient age, comorbidities, and pneumonia status when assessing risk and management strategies.
Use respiratory support measures as indicators for severity but recognize bacterial co-infection may not predict worse outcomes in RSV.
by Kristine L Karlsen, Clara L Clausen, Ragda A S Kahiyah, Aymen Alkarawi, Amanda M Egeskov-Cavling, Noor Hayder, Adin Sejdic, Casper Roed, Jon G Holler, Lene Nielsen, Mads F Eiberg, Omid Rezahosseini, Christian Østergaard, Zitta B Harboe, Thea K Fischer, Birgitte Lindegaard, Thomas Benfield
