The clinical impact of swabbing positive for multiple respiratory viruses

Little data exists on the clinical impact on adults who swab positive for more than one respiratory virus at once. Should this be associated with higher morbidity/mortality, there would be implications for patient care and potentially infection prevention measures. We reviewed 190 throat/nasopharyngeal swabs positive for respiratory viruses in York Teaching Hospitals NHS Foundation trust between October 2017 and February 2018. Data, collected from the hospital inpatient computer records, included: age, admission/discharge dates, presenting complaint, past medical history, time to swab (from admission), use of oseltamivir, flucloxacillin and other antibiotics, positive microbiology, highest recorded MEWS (excluding ITU), length of ITU stay and discharge status. The modal length of stay was 2-10 days. 69% of patients were aged over 40. There was no difference between admission to ITU and single/multiple respiratory viruses. The presence of influenza virus was higher in patients with a pre-existing cardiac comorbidity compared with pre-existing respiratory or other comorbidities. There did not appear to be a correlation between the number of patients with any comorbidity having multiple respiratory viruses. Interestingly, 18% of patients with multiple respiratory viruses died, compared with 10% of patients with singular viruses. Given the small numbers of patients included, further work is needed. A repeat review is planned across two hospital trusts in the near future.