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The global burden of lower respiratory tract infections is substantial, leading to many hospital admissions and deaths, especially among young children and older adults. (1) Respiratory viruses are responsible for [...], BACKGROUND: Data on the outcomes of noninfluenza respiratory virus (NIRV) infections among hospitalized adults are lacking. We aimed to study the burden, severity and outcomes of NIRV infections in this population. METHODS: We analyzed pooled patient data from 2 hospital-based respiratory virus surveillance cohorts in 2 regions of Canada during 3 consecutive seasons (2015/16, 2016/17, 2017/18; n = 2119). We included patients aged [greater than or equal to] 18 years who developed influenza-like illness or pneumonia and were hospitalized for management. We included patients confirmed positive for [greater than or equal to] 1 virus by multiplex polymerase chain reaction assays (respiratory syncytial virus [RSV], human rhinovirus/ enterovirus (hRV), human coronavirus (hCoV), metapneumovirus, parainfluenza virus, adenovirus, influenza viruses). We compared patient characteristics, clinical severity conventional outcomes (e.g., hospital length-of stay, 30-day mortality) and ordinal outcomes (5 levels: discharged, receiving convalescent care, acute ward or intensive care unit [ICU] care and death) for patients with NIRV infections and those with influenza. RESULTS: Among 2119 adults who were admitted to hospital, 1156 patients (54.6%) had NIRV infections (hRV 14.9%, RSV 12.9%, hCoV 8.2%) and 963 patients (45.4%) had influenza (n = 963). Patients with NIRVs were younger (mean 66.4 [standard deviation 20.4] yr), and more commonly had immunocompromising conditions (30.3%) and delay in diagnosis (median 4.0 [interquartile range (IQR) 2.0-7.0] days). Overall, 14.6% (12.4%-19.5%) of NIRV infections were acquired in hospital. Admission to ICU (18.2%, median 6.0 [IQR 3.0-13.0] d), hospital length-of-stay (median 5.0 [IQR 2.0-10.0] d) and 30-day mortality (8.4%; RSV 9.5%, hRV 6.6%, hCoV 9.2%) and the ordinal outcomes were similar for patients with NIRV infection and those with influenza. Age > 60 years, immuno-compromised state and hospital-acquired viral infection were associated with worse outcomes. The estimated median cost per acute care admission was $6000 (IQR $2000-$16 000). INTERPRETATION: The burden of NIRV infection is substantial in adults admitted to hospital and associated outcomes may be as severe as for influenza, suggesting a need to prioritize therapeutics and vaccines for at-risk people.

Yip, LilyC. (University of Cincinnati, Cincinnati, Ohio), Ramesh Shah, and Richard A. Day. Metabolic control of penicillinase biosynthesis in Bacillus cereus. J. Bacteriol. 88:297–308. 1964.—Penicillinase production in strains 5 and 5/B of Bacillus cereusin response to treatment by 6-aminopenicillanic acid (APA), penicillin G, (6-N-α-(p-benzyloxyphenoxy)-propionylamino-penicillanic acid, and cephalosporin C (CC) was found to be analogous to that seen in constitutive strains. Strain 5 did not release penicillinase into the medium to any great extent. Penicillinase production and the effect of the above penicillins on it were found to decline with increasing density of the culture. The penicillins were shown to accelerate or retard the production of penicillinase activity in strain 5 cells during pretreatment at 0 C and during incubation at 37 C. Strains 5 and 5/B gave qualitatively similar responses to penicillin treatment. At 0 C, the specific activity of penicillinase in strain 5 passes through a period of rapid increase at 0 hr and a period of little change at approximately 1 hr, followed by an increased rate of change towards 2 hr. The effect of APA or CC on specific activity of strain 5 cells during treatment at 0 C could not be reversed by one another, but Hg could reverse the increase caused by CC to some extent and the repression caused by APA. The production of penicillinase in the microconstitutive strain 5 of Bacillus cereusin response to treatment with CC was influenced by various inhibitors. 8-Azaguanine inhibited the production of the enzyme both during a pretreatment of the cells with CC at 0 C and during the subsequent incubation at 37 C. Actinomycin D, 6-azauracil, 6-thioguanine, and 2-thiocytosine inhibit the increase in penicillinase arising after the pretreatment at 0 C. 6-Azathymine has very little effect on the change of penicillinase activity. The CC-induced change occurring during the 0 C period was postulated to be a process at the level of protein biosynthesis itself; change at 37 C, constituting a delayed response, was considered a process at the level of messenger ribonucleic acid synthesis.