Inpatient Rsv-Management 2016–2022: Epidemiology and Adherence to A Bronchiolitis Treatment Standard at a German University Children’s Hospital

Abstract

Background This study analyzes the RSV season 2021/2022 in a referral children’s hospital, compares the epidemiology and illness severity with RSV-infected inpatients from 2016 to 2020 and audits the adherence to our internal therapy standard for RSV bronchiolitis.

Material and methods Inpatients with rtPCR-confirmed RSV infection (Jan. 2016 to Jan. 2022).

Results The audit comprises 306 RSV inpatients, on average 50 hospitalizations per year; in 03/2020, a rapid RSV Season-Offset was observed. In the winter season 2020/2021, no patient with RSV was hospitalized. Beginning in July, we noticed a rapid increase of RSV-admissions (most cases in Sept./Oct, duration until Dec. 2021; n=53). In 2021–2022, a significant larger share needed PICU admission (9.4% vs 3.2%, p=0.040). Adherence to the internal guidance was low; only 11.8% (n=36) of all patients received supportive treatment without inhalative or systemic medications, 37% of all patients received antibiotics.

Conclusions This audit confirms the strong impact of public preventive measures directed against SARS-CoV-2 transmission on RSV epidemiology. Few weeks after easing public COVID-19 restrictions (summer 2021), RSV inpatient cases rapidly increased, lasting until Dec. 2021. The audit of bronchiolitis management revealed surprisingly low adherence to the internal guidance, despite a face-to-face educational session with the attending pediatricians in Oct. 2021. Low adherence resulted in an unnecessary exposure of RSV patients to systemic medications of questionable benefit including antibiotics.

Zusammenfassung

Hintergrund In dieser Studie erfolgte eine prospektive Analyse der RSV Saison 2021/2022 in einem Universitätsklinikum. Dabei wurde die klinische Epidemiologie und der Schweregrad mit Daten RSV-infizierter Patienten von 2016–2020 verglichen. Zusätzlich wurde die Adhärenz zu einem internen Standard zur Therapie der RSV-Bronchiolitis überprüft.

Material und Methoden Stationäre Patienten mit rtPCR-bestätigter RSV-Infektion (Jan. 2016 bis Jan. 2022)

Ergebnisse Insgesamt wurden 306 stationär behandelten RSV-infizierte Patienten eingeschlossen, im Mittel 50 Kinder pro Jahr. Im März 2022 kam es zu einer raschen Abnahme der RSV Prävalenz. Ab Juli 2021 erfolgte dann ein steiler Anstieg mit (Maximum im Sept./Okt). dann eine abnehmende Zahl bis Dez. 2021 (n=53). 2021/2022 war der Anteil intensivmedizinisch behandelter Kinder signifikant höher (9,4% vs. 3,2% 2016–2020, p=0,040). Die Adhärenz zum klinikinternen Behandlungsstandard war niedrig, nur 11.8% der Patienten erhielten ausschließlich eine supportive Behandlung ohne weitere inhalative oder systemische Therapie, 37% der Patienten erhielten Antibiotika.

Zusammenfassung Dieses Audit bestätigt den starken Einfluss des SARS-CoV-2- Infektionsschutzes auf die RSV Epidemiologie. Nach Beendigung der Schutzmaßnahmen gab es im Sommer 2021 einen Anstieg stationär behandelter RSV-Infektionen bis Dez. 2021. Die Adhärenz zum internen Behandlungsstandard war trotz einer erneuten Schulung des Personals (2021) niedrig, was zu einer hohen Exposition gegenüber wenig evidenz-basierten Therapien und Antibiotika führte.

Key words

Respiratory syncytial virus - bronchiolitis - epidemiology - clinical severity - treatment adherence

Schlüsselwörter

Respiratory Syncytial Virus - Bronchiolitis - Epidemiologie - Klinischer Schweregrad - Behandlungsadhärenz

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