RNA Respiratory Viral Infections In Solid Organ Transplant Recipients

Publication Date: March 1, 2019

RECOMMENDATIONS

DIAGNOSIS

All patients with presumed respiratory viral infection should have a nasopharyngeal swab, wash, or aspirate performed and sent for testing. (Very Low, Strong)
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In case of diagnostic uncertainty, especially with clinical or radiologic evidence of lower tract involvement, bronchoalveolar lavage should be sent for the range of available tests. (Very Low, Strong)
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PREVENTION OF INFLUENZA

Patients with influenza infection in a healthcare setting need to be isolated with standard and droplet measures. (Moderate, Strong)
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Inactivated influenza vaccine should be administered to all SOT recipients and household members. (High, Strong)
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In patients whom influenza vaccine is contraindicated or may have insufficient response (eg, therapy for acute rejection, early after transplantation), antiviral prophylaxis with oseltamivir 75 mg once daily for a duration of 12 weeks (renally adjusted if needed) starting at the beginning of the influenza season may be proposed. (High, Weak)
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In SOT recipients that are close contacts of a patient with documented influenza (in particular in cases of nosocomial influenza and in patients with enhanced immunosuppression), we suggest administering postexposure prophylaxis with oseltamivir. (Low, Strong)
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TREATMENT OF INFLUENZA

Transplant recipients should receive antiviral therapy with a neuraminidase inhibitor (either oseltamivir or inhaled zanamivir) when influenza is suspected. (Moderate, Strong)
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Although early (<48 hours) administration of antivirals is associated with better outcomes, all symptomatic patients should receive antiviral therapy, irrespective of duration of symptom onset. (Low, Strong)
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Duration of antiviral therapy should be at least 5 days. Antiviral therapy may be prolonged in cases of persistent clinical symptoms. (Low, Weak)
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Double dosing of oseltamivir may be considered in severe cases or in cases of insufficient response to therapy. (Low, Weak)
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IV drugs (peramivir or zanamivir) can be also used in selected cases (intubated patients, concerns with oral absorption). (Low, Weak)
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Resistance testing should be considered when clinical symptoms and/or viral shedding are present despite antiviral therapy. (, )
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DIAGNOSIS, TREATMENT, AND PREVENTION OF RESPIRATORY SYNCYTIAL VIRUS

Patients with known or suspected RSV should be isolated from other patients using standard and contact precautions. (Moderate, Strong)
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Prophylaxis with palivizumab may be considered for children <24 months of age who are profoundly immunocompromised during the RSV season. (Low, Strong)
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Treatment with aerosolized or oral ribavirin is recommended for lung transplant recipients with upper or lower respiratory tract infection. (Moderate, Weak)
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Addition of corticosteroids and IVIG to ribavirin can be considered for lung transplant recipients with upper or lower respiratory tract infection. (Low, Weak)
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Treatment with aerosolized or oral ribavirin of non‐lung solid organ recipients with lower respiratory tract disease can be considered. (Low, Weak)
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Recommendation Grading

Disclaimer

Overview

Title

Rna Respiratory Viral Infections In Solid Organ Transplant Recipients

Authoring Organization

Publication Month/Year

March 1, 2019

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of RNA respiratory viral infections in the pre‐ and post‐transplant period.

Target Patient Population

Pre-post transplant patients with viral infection

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Operating and recovery room, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Diagnosis, Prevention, Management

Diseases/Conditions (MeSH)

D019072 - Antibiotic Prophylaxis, D019737 - Transplants, D000998 - Antiviral Agents

Keywords

antiviral, infection prevention, antimicrobial prophylaxis, infection, antibiotic