Viral Infection Is Not Uncommon in Adult Patients with Severe Hospital-Acquired Pneumonia

Abstract

BackgroundViral pathogens have not generally been regarded as important causes of severe hospital-acquired pneumonia (HAP), except in patients with hematologic malignancy or transplant recipients. We investigated the role and distribution of viruses in adult with severe HAP who required intensive care.MethodsFrom March 2010 to February 2012, adult patients with severe HAP required admission to the intensive care unit (ICU), 28-bed medical ICU in a tertiary care hospital, were prospectively enrolled. Respiratory viruses were detected using multiplex reverse-transcription polymerase chain reaction and/or shell vial culture.ResultsA total of 262 patients were enrolled and 107 patients (40.8%) underwent bronchoscopic BAL for etiologic diagnosis. One hundred and fifty-six patients (59.5%) had bacterial infections and 59 patients (22.5%) had viral infections. Viruses were detected in BAL fluid specimens of 37 patients (62.7%, 37/59). The most commonly identified viruses were respiratory syncytial virus and parainfluenza virus (both 27.1%, 16/59), followed by rhinovirus (25.4%, 15/59), and influenza virus (16.9%, 10/59). Twenty-one patients (8.0%, 21/262) had bacterial-viral coinfections and Staphylococcus aureus was the most commonly coexisting bacteria (n = 10). Viral infection in non-immunocompromised patients was not uncommon (11.1%, 16/143), although it was not as frequent as that in immunocompromised patients (36.4%, 43/119). Non-immunocompromised patients were significantly older than immunocompromised patients and had significantly higher rates of underlying chronic obstructive pulmonary disease, tuberculous destroyed lung and chronic kidney disease. The 28 day mortalities of patients with bacterial infections, viral infections and bacterial-viral coinfections were not significantly different (29.5%, 35.6% and 19.0%, respectively; p = 0.321).ConclusionsViral pathogens are not uncommon in adult patients with severe HAP who required ICU admission. Since viral pathogens may cause severe HAP and could be a potential source of viral transmission, further investigation is required to delineate the role of viral pathogens in severe HAP.

Laboratory-based surveillance of hospital-acquired respiratory virus infection in a tertiary care hospital

“…10 It has also been reported that respiratory viruses were responsible for 22.5% of cases of severe hospital-acquired pneumonia requiring ICU admission in adults. 11 These results strongly suggest that hospital-acquired infections caused by respiratory viruses could lead to serious consequences.…”

Influenza and Viral Pneumonia

“…The identified viruses were respiratory syncytial virus (6.1%), parainfluenza virus (6.1%), influenza virus (3.8%), cytomegalovirus (1.9%), human coronavirus (1.5%), bocavirus (0.8%), human metapneumovirus (0.8%), and adenovirus (0.4%). 28 These data underscore the importance of infection control measures in patients with pneumonia.…”

Viral Pneumonia and Acute Respiratory Distress Syndrome

“…[7][8][9] Although no studies have reported the incidence of ARDS specifically caused by viral pneumonia, epidemiologic surveys of adults admitted to the intensive care unit (ICU) with pneumonia and respiratory failure suggest that respiratory viruses are a common cause of severe pneumonia. 10,11 In the Etiology of Pneumonia in the Community (EPIC) study, a population-based surveillance for CAP, respiratory viruses were identified in 22% of adults admitted to the ICU with radiographically proven pneumonia. 12 In a prospective, observational study of consecutive patients admitted to an ICU with CAP in 6 hospitals in Kentucky, respiratory viruses were identified in 23% of adults.…”