1600. An Optimal Respiratory Syncytial Virus (RSV) Treatment in Lung Transplant Recipients: Oral Ribavirin, Inhaled Ribavirin, or Conservative Approach. (26th November 2018)

• Record Type: Journal Article
• Authors: Permpalung, Nitipong; Thaniyavarn, Tany; Saullo, Jennifer; Arif, Sana; Miller, Rachel; Reynolds, John; Alexander, Barbara D
• Is Part Of: Open forum infectious diseases. Volume 5(2018)Supplement 1
• Page Start: S501
• Page End: S502
• Publication Date: 2018-11-26
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofy210.1428
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Respiratory syncytial virus (RSV) is a common community acquired infection in lung transplant recipients (LTRs). The mortality in RSV-infected LTRs has been reported as 10–20% despite antiviral therapy; however, there is no consensus regarding treatment given limited data. Methods: A retrospective study of all LTRs at Duke University during January 2013 and May 2017 with a positive RSV PCR respiratory specimen was performed. Baseline characteristics, sites of infection, antiviral therapy, side effects, outcomes including all-cause 1-year mortality post RSV infection, and 90-day readmission rates were analyzed. The Cox proportional hazard model was used to adjust the effect of ribavirin (RBV) on mortality. Results: One hundred fourteen RSV-infected LTRs were identified: 70 received oral RBV, 32 inhaled RBV and 12 supportive care only. Baseline characteristics were similar between the 3 groups except site of infection and oxygen requirement at diagnosis (see table). Of 32 patients treated with inhaled RBV, 19 had a creatinine clearance <40 mL/minute and 8 were unable to take oral drugs. Unadjusted all-cause 1-year mortality was highest in the supportive care group [33.3% vs. 7.1% (oral RBV) vs. 25% (inhaled RBV), P = 0.01]. There were no significant differences in readmission rates among the 3 groups. The adjusted hazard ratio (HR) for death and oral RBV use was 0.27 ([0.07, 1.1], P = 0.07). The adjusted HR for death and inhaled RBV use was 0.90 ([0.22, 3.68], P = 0.88). RBV was stopped prematurely in only 1 patient in the oral group due to nausea and vomiting. Conclusion: Oral and inhaled RBV appear to be well tolerated in LTRs. Our data support the use of oral RBV as a safe alternative to inhaled RBV in LTRs. Additional studies are required to determine whether LTRs with asymptomatic RSV infection would benefit from RBV therapy. Disclosures: R. Miller, scynexis: Investigator, Research support.