Symptomatologie und klinischer Verlauf bei hospitalisierten Erwachsenen mit Virusinfektionen durch Influenza A und Respiratory Syncytial-Virus (RSV)

Zusammenfassung

Einleitung Zum klinischen Profil und Verlauf von komplizierten Infektionen mit RSV bei Erwachsenen im Vergleich zur Influenza A ist wenig bekannt. Die vorliegende Untersuchung hatte deshalb zum Ziel. prädisponierende Grunderkrankungen, klinisches Profil, Verlauf und Prognose bei hospitalisierten Patienten mit RSV- und Influenza-A-Infektionen miteinander zu vergleichen.

Material und Methode Eingeschlossen wurden Patienten mit RSV- und Influenza-A-Infektionen, die zwischen 1.1.2017 und 31.3.2017 hospitalisiert wurden. Die Diagnostik erfolgte mittels molekularbiologischer Verfahren. Zur Charakterisierung wurden klinische Symptome, Laborparameter sowie disponierende chronische Grunderkrankungen erfasst. Darüber hinaus wurde Verlauf und Schwere der Infektion anhand verschiedener klinischer Parameter einschließlich Beatmungspflichtigkeit und Letalität abgeschätzt.

Ergebnisse Insgesamt wurden 190 Patienten mit Influenza-A- und 98 Patienten mit RSV-Infektion ausgewertet. Sowohl das mittlere Alter als auch die klinische Symptomatologie bei Diagnosestellung waren in beiden Patientengruppen vergleichbar. Nur 2/3 der Patienten zeigten Influenza-typische respiratorische Symptome. Zwischen 13 und 16 % der Infektionen waren nosokomialen Ursprungs. Bezüglich des klinischen Verlaufs mussten insbesondere Patienten mit RSV-Infektion und einer chronischen Lungenerkrankung signifikant häufiger invasiv beatmet werden (odds ratio 10,55 [95 % CI 1,18 – 507,1] p = 0,014).

Schlussfolgerung RSV-Infektionen kommen als häufige Ursache von komplizierten Influenza-ähnlichen Erkrankungen bei älteren, hospitalisierten Patienten in Frage. Im Vergleich zur Influenza A verlaufen RSV-Infektionen insbesondere bei einer chronischen Lungenerkrankung schwerer. Bei beiden Entitäten ist ein nicht unerheblicher Teil der Infektionen nosokomialen Ursprungs, was im Hinblick auf ein erfolgreiches Hygienemanagement eine möglichst rasche Diagnosestellung impliziert.

Abstract

There is little evidence on the clinical characteristics and the course of complicated infections with respiratory syncytial virus (RSV) compared to influenza A in adults. Therefore, the present monocenter study aims to compare infections with RSV and influenza A with regard to potential predisposing factors, clinical profile, course and outcome in hospitalized patient.

Material and methods the study was performed between Jan 1th and March 31 this year and included all hospitalized patients with a Polymerase chain-reaction-(PCR) confirmed infection of influenza A and RSV. Patients were characterized by clinical symptoms at the time of diagnosis, laboratory parameters of inflammation and potential predisposing factors like chronical diseases of heart, lung, kidney, metabolism and tumors. Data on the length of hospital stay, origin of infection (nosocomial), rate of pneumonia, antimicrobial use, need of mechanical ventilation and hospital mortality were obtained to evaluate clinical severity and outcome.

Results A total of 190 patients with Influenza A and 98 patients with RSV were included. Both patient groups did not differ with regard to anthropometric data and clinical symptoms: it was surprising to see that only 2/3 oft all patients exert symptoms of a respiratory infection. 15.3 % of influenza A and 13.3 % RSV infections were defined as being nosocomial. Comparing the clinical course and outcome, patients with RSV infections and chronical disease of the lung had an increased rate of mechanical ventilations (odds ratio 10.55 [95 % CI 1.18 – 507.1] p = 0.014).

Conclusions The present data clearly show that RSV is a frequent pathogen in hospitalized adults with complicated infections in the winter season. RSV infections seems to be more severe compared to influenza A particular in patients with chronic lung disease, but were as frequent as influenza A of nosocomial origin. In this context, an early diagnosis seems to be helpful for a successful infections prevention management under hospital conditions.

Schlüsselwörter

Erwachsene - Influenza A - RSV - klinischer Verlauf

Key words

adults - influenza A - RSV - complicated infections

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