Abstract
BackgroundClinical guidelines suggest testing for respiratory viruses during the influenza season, but are unclear which categories of patients on the intensive care unit (ICU) should be tested. ObjectiveWe described the clinical practice of diagnostic testing for respiratory virus infections in patients presenting to ICU with suspected community-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP). Study designProspective observational study in consecutive CAP and HAP patients with an ICU stay of more than 24h in two tertiary care hospitals in The Netherlands, from 2011 to December 2013. The proportion of patients receiving diagnostic testing with PCR for the presence of respiratory viruses in respiratory tract specimens was determined. ResultsIn total, 1452 patients were included, of which 712 patients presented with CAP and 740 with HAP. In CAP, 282 of 712 (40%) were tested for respiratory viruses (190 of 417 (46%) during the influenza season). In HAP, 95 of 740 (13%) were tested (50 of 372 (13%) during the influenza season). Regardless of the season, virus diagnostic tests were ordered significantly more often in patients with comorbidities, and in those presenting with elevated CRP and leucopenia. In patients who were tested during the influenza season, the prevalence of influenza was 14% in patients with CAP and 10% in those with HAP. Influenza was absent during the summer in both groups. ConclusionsLess than half of patients admitted to the ICU with suspected pneumonia were tested for the presence of viral pathogens, either in or outside the influenza season.
Highlights
Clinical guidelines suggest testing for respiratory viruses during the influenza season, but are unclear which categories of patients on the intensive care unit (ICU) should be tested
In the group of patients admitted to the ICU with a suspected community-acquired pneumonia (CAP), 282 of 712 patients (40%) were tested for respiratory viruses; of patients admitted with a suspected hospital-acquired pneumonia (HAP), 95 of 740 (13%) were tested (P =
Our study shows that 46% of patients admitted to the ICU with a suspected CAP during the influenza season was tested for the presence of viral pathogens, whereas 32% of CAP patients was tested outside the season
Summary
Clinical guidelines suggest testing for respiratory viruses during the influenza season, but are unclear which categories of patients on the intensive care unit (ICU) should be tested. Epidemiological studies show that the prevalence of viral respiratory tract infections can be as high as 41% in critically ill patients admitted to the intensive care unit (ICU) with a suspected CAP, and up to 34% in hospital-acquired pneumonia (HAP) [2,3,4,5,6]. Detection of such infections in critically ill patients may have important implications for infection control measures such as isolation and, in case of (suspected) influenza, rapid initiation of antiviral medication [7,8]. The current practice of testing for the presence of viral pathogens in critically ill patients with a suspected CAP or HAP is unknown
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