Multicountry prospective surveillance (id.DRIVE study) of adults (≥18 years) hospitalised with SARI across 17 hospitals in Spain, Italy, and Germany (September 2024–August 2025), testing for SARS-CoV-2, RSV, influenza A/B, and additional pathogens at select sites.
Among 8,730 hospitalised adults (median age 77), influenza A was the most common pathogen (14.3%, n=1,249), followed by SARS-CoV-2 (6.9%, n=606), RSV (6.4%, n=554), and influenza B (0.8%, n=74). RSV patients were oldest (median 80 years), had the highest comorbidity burden (62.3% with ≥3 chronic conditions), required oxygen in 72.0%, non-invasive ventilation in 12.3%, and had 9.4% in-hospital mortality. Over 75% of virus-positive SARI patients received antibiotics during hospitalisation.
- Testing for pathogens beyond SARS-CoV-2, RSV, and influenza varied by hospital, limiting comparability across sites. - Study restricted to three European countries (Spain, Italy, Germany), limiting generalisability to broader European populations. - Observational design with no comparator group precludes causal inference.
RSV carries a high clinical burden in older hospitalised adults — comparable to or exceeding influenza — underscoring the need for RSV vaccination strategies in this age group. The high rate of antibiotic use (>75%) in virus-confirmed SARI warrants targeted antimicrobial stewardship efforts.
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