465Systemic Ribavirin Therapy for Respiratory Syncytial Virus Infections in Pediatric Solid Organ Transplant Patients: A single hospital experience over 3 RSV seasons

Abstract Background While data are limited, oral ribavirin (RBV) has been shown to be a cost-effective alternative to aerosolized RBV for the treatment of respiratory syncytial virus (RSV) in immunocompromised patients with significant reductions in acquisition and administration costs. We evaluated the clinical and economic impact of an RBV intervention program at a large, academic medical center. Methods This single-center, retrospective cohort study evaluated hematopoietic cell and solid-organ transplant patients admitted to Duke University Hospital (DUH) with documented or suspected RSV receiving aerosolized and/or oral RBV from July 2013 to April 2018. The ID consult service approval requirement was initiated for aerosolized RBV beginning in October 2015. Education was done at this time to promote oral RBV as the preferred therapy for immunocompromised, RSV-infected adults and children. No restrictions or treatment protocols were in place prior to that time for either formulation. Clinical outcomes, adverse effects, and drug acquisition cost were collected. A cost-avoidance analysis was performed using DUH acquisition cost for actual and alternate RBV therapy. Results A total of 118 treatments (115 unique adult and pediatric patients) were included. Demographics were comparable between groups with and median age was 52 years in the Oral RBV and 61 years in the Aerosol RBV group. The predominant transplant type was lung (62.5% in Oral RBV and 55.6% in Aerosol RBV) followed by hematopoietic (16.7% in Oral RBV and 27% in Aerosol RBV). The median (range) duration of therapy was 4 (1–16) days for oral RBV and 5 (1–23) days for aerosolized RBV. The total cost avoidance was $2,522,915 with oral RBV. Clinical outcomes are summarized in Table 1. Conclusion In our large tertiary care center, the use of oral RBV led to substantial cost avoidance with clinical outcomes comparable to aerosolized RBV in immunocompromised patients. Larger prospective trials evaluating oral RBV for RSV treatment are warranted. Disclosures All authors: No reported disclosures.

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40 Respiratory syncytial virus infections in lung transplant patients: Different therapeutic approaches linked to the degree of immunosuppression

International Journal of Infectious Diseases ◽

10.1016/s1201-9712(06)80038-x ◽

2006 ◽

Vol 10 ◽

pp. S22-S23

Author(s):

I. Uçkay ◽

P. Gasche-Soccal ◽

L. Kaiser ◽

J. Mazza-Stalder ◽

C. Van Delden

Keyword(s):

Respiratory Syncytial Virus ◽

Lung Transplant ◽

Virus Infections ◽

Therapeutic Approaches ◽

Respiratory Syncytial Virus Infections ◽

Transplant Patients ◽

Syncytial Virus

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Nosocomial Respiratory Syncytial Virus Infections: Prevention and Control in Bone Marrow Transplant Patients

Infection Control and Hospital Epidemiology ◽

10.2307/30141248 ◽

1997 ◽

Vol 18 (6) ◽

pp. 412-416 ◽

Cited By ~ 42

Author(s):

Ricardo Garcia ◽

Issam Raad ◽

Dima Abi-Said ◽

Gerald Bodey ◽

Richard Champlin ◽

...

Keyword(s):

Bone Marrow ◽

Respiratory Syncytial Virus ◽

Bone Marrow Transplant ◽

Prevention And Control ◽

Marrow Transplant ◽

Virus Infections ◽

Respiratory Syncytial Virus Infections ◽

Transplant Patients ◽

Syncytial Virus ◽

And Control

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1103. Respiratory Virus Infections In Solid Organ Transplant Recipients: A Single Center Experience

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1289 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S581-S582

Author(s):

Maria A Mendoza ◽

Mohammed A Raja ◽

Gemma Rosello ◽

Shweta Anjan ◽

Jacques Simkins ◽

...

Keyword(s):

Intensive Care ◽

Lung Transplant ◽

Respiratory Virus ◽

Organ Transplant ◽

Solid Organ Transplant ◽

Solid Organ ◽

Transplant Recipients ◽

Virus Infections ◽

Transplant Patients ◽

Respiratory Virus Infections

Abstract Background Community acquired respiratory virus infections (RVI) are a major concern in solid organ transplant (SOT) recipients due to severe complications such as lower respiratory tract infection (LRTI), superimposed fungal and bacterial pneumonia, intensive care admission and mortality. Besides influenza and respiratory syncytial virus (RSV), there is paucity of data of RVI in SOT recipients. Table 1: Patients characteristics Table 2: Concomitant infections Methods Retrospective cohort study of a single large transplant center was performed. Data of multiplex qualitative PCR-based respiratory viral panel (RVP) samples collected between January 2017 and December 2019 were included. It is important to mention that our institution generally performs the RSV/influenza rapid detection assay as an initial test; if negative, the multiplex PCR panel is usually done. We did not include results from the RSV/influenza rapid test in this study. Results One hundred transplant patients with a single positive RVP were included (table 1). Transplanted organs include kidney (40%), followed by lung (33%) and liver (9%). Most common presenting symptoms were cough (52%), shortness of breath (28%) and rhinorrhea (26%). Of note fever was seen in only 24%. Most common RVI was Rhinovirus/Enterovirus (RHV/ENT) (59%), followed by non-SARS-CoV-2 Coronavirus (19%) and Parainfluenza (PIV) (14%). None of the patients had neutropenia, however, 52% had lymphocytopenia. Lung transplant patients developed LRTI in 70% of cases compared to non-lung transplant 64% (p=0.412). Multivariate analysis showed patients with PIV 3 were less likely to develop LRTI (p= 0.038). Significant Cytomegalovirus DNAemia (>137 IU/mL) was noted in 9.8% of the recipients. No proven or probable pulmonary fungal infection were noted within 3 months after diagnosis of RVI. Five patients were admitted to the Intensive care unit due to septic shock. Three patients died at 4, 5 and 35 days after diagnosis of RHV/ENT, PIV-3 and RHV/ENT respectively. Conclusion Most of the cases of RVI were due to RHV/ENT. Patients with PIV 3 were less likely to develop LRTI. Lung transplant recipients developed LRTI with similar incidence to non-lung recipients. Our data shows a very low mortality of 3% after RVI in our SOT cohort, which warrants larger studies. Disclosures Michele I. Morris, MD, Viracor Eurofins (Advisor or Review Panel member)

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