Abstract
BackgroundInformation on the clinical, epidemiological and molecular characterization of human metapneumovirus in critically ill adult patients with severe community-acquired pneumonia (CAP) and the role of biomarkers identifying bacterial coinfection is scarce.MethodsThis is a retrospective epidemiological study of adult patients with hMPV severe CAP admitted to ICU during a ten-year period with admission PSI score ≥ 3.ResultsThe 92.8% of the 28 patients with severe CAP due to human metapneumovirus were detected during the first half of the year. Median age was 62 years and 60.7% were male. The genotyping of isolated human metapneumovirus showed group B predominance (60.7%). All patients had acute respiratory failure. Median APACHE II and SOFA score were 13 and 6.55, respectively. The 25% were coinfected with Streptococcus pneumoniae. 60.7% of the patients had shock at admission and 50% underwent mechanical ventilation. Seven patients developed ARDS, three of them younger than 60 years and without comorbidities. Mortality in ICU was 14.3%. Among survivors, ICU and hospital stay were 6.5 and 14 days, respectively. Plasma levels of procalcitonin were higher in patients with bacterial coinfection (18.2 vs 0.54; p < 0.05). The levels of C-reactive protein, however, were similar.ConclusionHuman metapneumovirus was associated with severe CAP requiring ICU admission among elderly patients or patients with comorbidities, but also in healthy young subjects. These patients often underwent mechanical ventilation with elevated health resource consumption. While one out of four patients showed pneumococcal coinfection, plasma procalcitonin helped to implement antimicrobial stewardship.
Highlights
Information on the clinical, epidemiological and molecular characterization of human metapneumovirus in critically ill adult patients with severe community-acquired pneumonia (CAP) and the role of biomarkers identifying bacterial coinfection is scarce
HMPV was consistently detected in CAP admitted to the intensive care unit (ICU), with an annual incidence ranging 0.5–1 case/100,000 inhabitants older than 14 years per year
These findings suggest the need to implement Human metapneumovirus (hMPV) diagnosis tests in subjects with CAP developing acute respiratory failure
Summary
Information on the clinical, epidemiological and molecular characterization of human metapneumovirus in critically ill adult patients with severe community-acquired pneumonia (CAP) and the role of biomarkers identifying bacterial coinfection is scarce. Respiratory tract infections caused by hMPV during adulthood are less prevalent and less serious than those. The presence of hMPV has been detected in 2–4% of adult patients admitted due to a community-acquired pneumonia (CAP) [8, 9] and has been associated with asthma and chronic obstructive pulmonary disease exacerbation [10,11,12]. Recent studies suggest that hMPV infection is an underappreciated cause of critical illness, in previously healthy patients [15,16,17,18]
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