Purpose <p>Although respiratory syncytial virus (RSV) infection in adults is considered as an important health issue, the characteristics and outcomes of hospitalized adults with RSV infection remains limited. We conducted a retrospective study on adult inpatients with RSV infection to explore the clinical characteristics and effects of RSV infection in different age groups, trying to find out the above characteristics of elderly patients, guide the early clinical diagnosis and treatment of RSV infection and improve the clinical outcomes in this population.</p> Methods <p>Base on the retrospective enrollment of RSV infection patients hospitalized in Tianjin Chest Hospital, compare the clinical characteristics, treatments and outcomes of different groups according to age. Binary logistic regression model was used to analyze the factors associated with the in-hospital mortality.</p> Results <p>Compared with the non-elderly group, the elderly group had a higher proportion of fungal infections, common symptoms of cough, higher rate of receiving steroids and invasive ventilation, higher hospitalization expenses and in-hospital mortality. Over 70 years old (OR 5.555 [95% CI, 1.311–23.542], <i>P</i> = 0.020) and bacterial co-infection (OR 3.789 [95% CI, 1.107–12.971], <i>P</i> = 0.034) were factors affecting the in-hospital mortality of patients with RSV infection.</p> Conclusion <p>The morbidity and mortality of RSV infection in adults should not be ignored, especially in elderly patients with high in-hospital mortality. Management and preventive strategies of RSV infection in these vulnerable groups is necessary.</p>