1496 - Aspergillosis Complicating Severe Respiratory Syncytial Virus (RSV) in ICU Patients: A Retrospective Cohort Study

Background: There are recent reports that identify severe influenza pneumonia as an independent risk factor for the development of invasive pulmonary aspergillosis (IPA), even in patients without immunocompromise. We aimed to understand the incidence of IPA as well as other coinfections over multiple seasons in patients with RSV pneumonia in the intensive care unit (ICU).

Methods: A retrospective cohort study was conducted in a single center in Chicago. Data was collected over 9 seasons (January 2009-March 2018) from adult patients admitted to the ICU at a large urban tertiary care center with severe RSV pneumonia. Patients were included if they had a positive RSV PCR test, older than 18 years, admitted to the ICU with acute respiratory failure, and had pulmonary infiltrates on imaging. IPA was defined per both the EORTC/MSG criteria as well as the revised AspICU criteria (Schauwvlieghe et al). Descriptive statistics were calculated. In univariable analysis, we compared categorical variables by Fisher’s exact test and Chi-square test, continuous variables by Wilcoxon Rank Sum where appropriate.

Results: Of 224 patients admitted to the ICU with RSV (median ICU LoS 10.5 d), IPA was diagnosed in 8 (3.5%). Patients diagnosed with IPA had an increased LoS in the hospital (23.7 days vs. 11.6 days, p=0.01). Although the mortality was numerically higher (3, 37.5% vs 26, 17.9%) this was statistically not significant). History of hematological malignancy, stem cell transplant, and neutropenia were significant factors in the development of IPA. Those with lung disease had significantly lower rates of IPA. All patients with IPA were treated with voriconazole. Other coinfections among RSV-infected ICU patients included bacterial (21, 13.7%), viral (10, 6.5%), and non-IPA fungal (13, 8.5%) pathogens.Baseline Characteristics and Mortality/Morbidity
Patient Characteristics in Invasive Pulmonary Aspergillosis


Conclusion: Although IPA is relatively uncommon in patients admitted to the ICU with severe RSV pneumonia, patients with IPA had significant increased LOS and tended to have underlying host factors. Other coinfections with bacterial, viral, and non-IPA fungal pathogens are common in those with severe RSV pneumonia.