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

Abstract 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), out of which 38 (66.6%) were males. 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 followed by rhinovirus (19.3%) and influenza (19.3%). 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. Death occurred in 4 (7.0%) patients. On inter-group analysis, non-de-escalation 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.