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

Guillaume Voiriot,Roland Smonig,Bruno Mourvillier,François-Xavier Lescure,Yazdan Yazdanpanah,Caroline Morbieu,Nadhira Houhou-Fidouh,Charles Burdet,Laurence Armand-Lefèvre,Aguila Radjou,Benoit Visseaux,Mathilde Neuville,Jean-Francois Soubirou,Jean-François Timsit,Johana Cohen,Stephane Ruckly,Liem Binh Luong Nguyen

doi:10.1186/s13054-016-1517-9

Abstract

BackgroundMultiplex polymerase chain reaction (mPCR) enables recovery of viruses from airways of patients with community-acquired pneumonia (CAP), although their clinical impact remains uncertain.MethodsAmong 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.ResultsAmong 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.ConclusionsViral-bacterial coinfection during severe CAP in adults is associated with an impaired presentation and a complicated course.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1517-9) contains supplementary material, which is available to authorized users.

Highlights

Multiplex polymerase chain reaction enables recovery of viruses from airways of patients with community-acquired pneumonia (CAP), their clinical impact remains uncertain
The final study group consisted of 174 patients (132 men (76 %), age 63 [53–75] years, Simplified Acute Physiologic Score (SAPS) Simplified Acute Physiology Score (II) 38 [27;55]) (Table 1)
At least one factor of immunosuppression was present in 32.8 % of patients

Summary

Introduction

Multiplex polymerase chain reaction (mPCR) enables recovery of viruses from airways of patients with community-acquired pneumonia (CAP), their clinical impact remains uncertain. Community-acquired pneumonia (CAP) is a common disease that may become severe, leading to admission to intensive care units (ICU) [1]. CAP etiology is usually bacterial; the causative role of respiratory viruses emerged recently [2]. Voiriot et al Critical Care (2016) 20:375 tract infections supported a pathogenic role of respiratory viruses during pneumonia [9]. The pathogenic role of respiratory viruses in virus-bacteria coinfected patients remains unclear. We conducted a comprehensive observational study among adult ICU patients with CAP, to compare clinical characteristics, biological presentation, and outcome according to the presence of virus in the respiratory tract

Methods

Results

Discussion

Conclusion