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Respiratory Viral Infections in Cancer Patients: Epidemiological, Clinical and Cost-Effectiveness study from a Developing Country

Author(s): Nitin Bansal, Neelam Sachdeva, Dinesh Bhurani, Gauri Kapoor, Pinky Yadav, Sumit Goyal, Vineet Talwar, Ullas Batra

Background: Diagnosis of respiratory viral pathogens can lead to therapeutic changes, improvement in infection control practices and reduction in use of antibiotics.

Methods: This is a retrospective study which looked into the case records of patients (June 2020-Dec 2021) who were diagnosed with a respiratory viral infection. Demographic, clinical and antibiotic prescription patterns of these patients were studied. Inter-group analysis was done between antibiotic de-escalation cohort and non-descalation cohort.

Results: Total of 57 patients were identified with median age of 40 years (range: 3-68). Hematological malignancies were present in 45 (78.9%) of patients, whereas 14 (24.5%) patients were stem cell transplant recipients. Severe neutropenia was seen in 32 (56.1%) patients with median duration of neutropenia of 7 (range 5-20) days. RSV (36.8%) was the most common virus detected. Antibiotic de-escalation was done in 33 (57.8%) of patients and in 13 (22.8%) bacterial co-infection was diagnosed. More than 3/4th patients were shifted to isolation and nearly 9000 INR per patient were saved by de-escalation of antibiotics. On inter-group analysis, non-deescalation cohort had longer length of stay (10 vs 3 days; p =0.005), no antibiotic cost reduction (0 vs 9620; p=0.0003), higher mortality (16.6% vs 0%; p =0.01) & higher rhinovirus detection rates (41.6% vs 3%; p=0.0002).

Conclusion: Diagnosis of respiratory viral infection helped in improving antibiotic stewardship and infection control practices.

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