Viral-bacterial coinfection affects the presentation and alters the prognosis of severe community-acquired pneumonia.

February 25, 2017 at 1:20 pm

Crit Care. 2016 Oct 25;20(1):375.

Voiriot G1,2, Visseaux B3, Cohen J4, Nguyen LB5, Neuville M4, Morbieu C5, Burdet C5, Radjou A4, Lescure FX5, Smonig R4, Armand-Lefèvre L6, Mourvillier B4, Yazdanpanah Y5,7, Soubirou JF4, Ruckly S8, Houhou-Fidouh N3, Timsit JF4,7.

Author information

1Service de Réanimation Médicale et Infectieuse, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris, France. guillaume.voiriot@aphp.fr

2Hôpital Bichat Claude Bernard, 46 rue Henri Huchard, Paris, 75018, France. guillaume.voiriot@aphp.fr

3Service de Virologie, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris, France.

4Service de Réanimation Médicale et Infectieuse, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris, France.

5Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris, France.

6Service de Microbiologie, Hôpital Bichat Claude Bernard, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris, France.

7Université Paris Diderot-Paris VII, Paris, France.

8Université de Grenoble 1, Center U823 Epidemioloy of Cancers and Severe Diseases, La Tronche, France.

Abstract

BACKGROUND:

Multiplex polymerase chain reaction (mPCR) enables recovery of viruses from airways of patients with community-acquired pneumonia (CAP), although their clinical impact remains uncertain.

METHODS:

Among consecutive adult patients who had undergone a mPCR within 72 hours following their admission to one intensive care unit (ICU), we retrospectively included those with a final diagnosis of CAP. Four etiology groups were clustered: bacterial, viral, mixed (viral-bacterial) and no etiology. A composite criterion of complicated course (hospital death or mechanical ventilation > 7 days) was used. A subgroup analysis compared patients with bacterial and viral-bacterial CAP matched on the bacterial pathogens.

RESULTS:

Among 174 patients (132 men [76 %], age 63 [53-75] years, SAPSII 38 [27;55], median PSI score 106 [78;130]), bacterial, viral, mixed and no etiology groups gathered 46 (26 %), 53 (31 %), 45 (26 %) and 30 (17 %) patients, respectively. Virus-infected patients displayed a high creatine kinase serum level, a low platelet count, and a trend toward more frequent alveolar-interstitial infiltrates. A complicated course was more frequent in the mixed group (31/45, 69 %), as compared to bacterial (18/46, 39 %), viral (15/53, 28 %) and no etiology (12/30, 40 %) groups (p < 0.01). In multivariate analysis, the mixed (viral-bacterial) infection was independently associated with complicated course (reference: bacterial pneumonia; OR, 3.58; CI 95 %, 1.16-11; p = 0.03). The subgroup analysis of bacteria-matched patients confirmed these findings.

CONCLUSIONS:

Viral-bacterial coinfection during severe CAP in adults is associated with an impaired presentation and a complicated course.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5112669/pdf/13054_2016_Article_1517.pdf

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Entry filed under: Antimicrobianos, Bacterias, Bacteriemias, Biología Molecular, Epidemiología, Infecciones respiratorias, Infecciones virales, Metodos diagnosticos, Sepsis, Update.

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