Format

Send to

Choose Destination
Clin Infect Dis. 2014 Jul 1;59(1):62-70. doi: 10.1093/cid/ciu237. Epub 2014 Apr 11.

Lower respiratory tract virus findings in mechanically ventilated patients with severe community-acquired pneumonia.

Author information

1
Department of Anaesthesiology, Division of Intensive Care.
2
Department of Virology, University of Turku, Finland.
3
Department of Anaesthesiology and Surgery.
4
Department of Infection Control, Oulu University Hospital, Medical Research Center Oulu.

Abstract

BACKGROUND:

The role of viral infections in the etiology of severe community-acquired pneumonia (SCAP) was prospectively evaluated from 2008 to 2012 at a university-level intensive care unit.

METHODS:

Clinical data and microbiological tests were assessed: blood cultures, urine pneumococcal and legionella antigens, Mycoplasma pneumoniae and Chlamydia pneumoniae antibodies from paired serums, and respiratory virus detection by multiplex, real-time polymerase chain reaction (PCR) from nasopharyngeal swabs and lower tracheal specimens via intubation tube.

RESULTS:

Of 49 mechanically ventilated SCAP patients (21 men and 28 women; median age, 54 years), the etiology was identified in 45 cases (92%). There were 21 pure bacterial infections (43%), 5 probably pure viral infections (10%), and 19 mixed bacterial-viral infections (39%), resulting in viral etiology in 24 patients (49%). Of 26 viruses, 21 (81%) were detected from bronchial specimens and 5 (19%) from nasopharyngeal swabs. Rhinovirus (15 cases, 58%) and adenovirus (4 cases, 15%) were the most common viral findings. The bacterial-viral etiology group had the highest peak C-reactive protein levels (median, 356 [25th-75th percentiles, 294-416], P = .05), whereas patients with probably viral etiology had the lowest peak procalcitonin levels (1.7 [25th-75th percentiles, 1.6-1.7]). The clinical characteristics of pure bacterial and mixed bacterial-viral etiologies were comparable. Hospital stay was longest among the bacterial group (17 vs 14 days; P = .02).

CONCLUSIONS:

Viral findings were demonstrated in almost half of the SCAP patients. Clinical characteristics were similar between the pure bacterial and mixed bacterial-viral infections groups. The frequency of viral detection depends on the availability of PCR techniques and lower respiratory specimens.

KEYWORDS:

etiology; intensive care; severe community-acquired pneumonia; viral infection

PMID:
24729498
PMCID:
PMC4305142
DOI:
10.1093/cid/ciu237
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Silverchair Information Systems Icon for PubMed Central
Loading ...
Support Center