Abstract
BackgroundThis study aimed to investigate the impact of preceding respiratory viral infections (RVI) on the clinical severity of pneumococcal pneumonia patients.MethodsA retrospective observational study was conducted at a university hospital from January 2009 to March 2013. Study subjects included adults (aged ≥18 years) with pneumococcal pneumonia who had undergone laboratory tests for RVI. Multivariate logistic regression analysis was performed to identify risk factors associated with severe pneumococcal pneumonia, defined as severity with the Pneumonia Severity Index (PSI) score ≥91.ResultsIn total, 191 patients with pneumococcal pneumonia were included for analysis and stratified into 2 groups: the severe group with a PSI score ≥91 (n = 99) and the non-severe group with a PSI score <91 (n = 92). Preceding RVIs were detected in 48 patients, including influenza A virus (n = 20), influenza B virus (n = 4), parainfluenza viruses (n = 5), metapneumovirus (n = 4), rhinovirus (n = 4), respiratory syncytial viruses (n = 6), coronaviruses (n = 2), and mixed viral infections (n = 3). In the multivariate logistic regression analysis, preceding RVIs (odds ratio [OR], 2·49; 95% confidence interval [CI], 1·10–5·60), male sex (OR, 2·58; 95% CI, 1·24–5·38), old age (OR, 2·92; 95% CI, 1·37–6·24), hypoalbuminemia (OR, 3·26; 95% CI, 1·56–6·84)], and azotemia (OR, 2·24; 95% CI, 1·08–4·67) were significantly associated with severe pneumococcal pneumonia.ConclusionThis study suggests that preceding RVIs might be one of the risk factors affecting the clinical severity of pneumococcal pneumonia.
Highlights
This study aimed to investigate the impact of preceding respiratory viral infections (RVI) on the clinical severity of pneumococcal pneumonia patients
It has been observed that polymerase chain reaction (PCR)-based testing allows the detection of various respiratory viruses and viral–bacterial co-infection might be associated with severe diseases.[10,11,12,13,14]
We investigated the impact of preceding respiratory virus infection (RVI) on the clinical severity of pneumococcal pneumonia
Summary
This study aimed to investigate the impact of preceding respiratory viral infections (RVI) on the clinical severity of pneumococcal pneumonia patients. Known prognostic factors for mortality due to pneumococcal pneumonia include old age, male sex, preexisting lung diseases, solid organ tumors, nosocomial infections, leukopenia, low body temperature, urea nitrogen level >30 mg/dl, hypoalbuminemia, hypoxemia, septic shock, and high severity scores.[6,7,8,9] preceding respiratory virus infection (RVI) as a potential risk factor for severe pneumococcal pneumonia was not evaluated in these studies due to the unavailability of routine virological diagnostic assays.[6,7,8,9] It has been observed that polymerase chain reaction (PCR)-based testing allows the detection of various respiratory viruses and viral–bacterial co-infection might be associated with severe diseases.[10,11,12,13,14] Despite advances in medical care, mortality from pneumococcal pneumonia still ranges from 11% to 20%.4,5 Known prognostic factors for mortality due to pneumococcal pneumonia include old age, male sex, preexisting lung diseases, solid organ tumors, nosocomial infections, leukopenia, low body temperature, urea nitrogen level >30 mg/dl, hypoalbuminemia, hypoxemia, septic shock, and high severity scores.[6,7,8,9] preceding respiratory virus infection (RVI) as a potential risk factor for severe pneumococcal pneumonia was not evaluated in these studies due to the unavailability of routine virological diagnostic assays.[6,7,8,9] It has been observed that polymerase chain reaction (PCR)-based testing allows the detection of various respiratory viruses and viral–bacterial co-infection might be associated with severe diseases.[10,11,12,13,14]
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