Respiratory viral detection in adult severe acute respiratory infection post-COVID-19 pandemic: implications for antimicrobial stewardship

OBJECTIVES: To characterise epidemiology, management, and outcomes of adult severe acute respiratory infection (SARI) in the post-COVID-19 era using virological surveillance and linked clinical data, and to explore implications for antimicrobial stewardship. METHODS: Prospective observational cohort study of adults hospitalised with SARI at a tertiary hospital in Glasgow, UK between January 2023-March 2024. Upper respiratory tract swabs underwent multiplex respiratory viral RT-PCR in addition to routine SARS-CoV-2 and influenza point-of-care testing (POCT), with linkage to routinely collected NHS data. RESULTS: Among 780 participants, respiratory samples were available for 676. ≥1 respiratory virus was detected in 46.5% by multiplex PCR, compared with 20.0% by routine POCT. SARS-CoV-2 and rhinovirus were most frequently detected. Chronic lung disease was associated with increased detection of viruses not included in routine testing. Empirical antibiotics was common (73% at admission). Positive SARS-CoV-2/influenza POCT at admission was associated with reduced odds of antibiotic prescribing (aOR 0.15, 95% CI 0.08-0.28) and shorter hospital stay. CONCLUSION: Respiratory viruses were identified in nearly half of adult SARI, exceeding the yield of routine testing. Early virological diagnosis using POCT was associated with lower antibiotic use and shorter hospital stay. Expanded rapid respiratory viral testing may support antimicrobial stewardship but require further evaluation.