Abstract
BackgroundViral pathogens have not generally been regarded as important causes of severe hospital-acquired pneumonia (HAP), except in patients with hematologic malignancy or transplant recipients. We investigated the role and distribution of viruses in adult with severe HAP who required intensive care.MethodsFrom March 2010 to February 2012, adult patients with severe HAP required admission to the intensive care unit (ICU), 28-bed medical ICU in a tertiary care hospital, were prospectively enrolled. Respiratory viruses were detected using multiplex reverse-transcription polymerase chain reaction and/or shell vial culture.ResultsA total of 262 patients were enrolled and 107 patients (40.8%) underwent bronchoscopic BAL for etiologic diagnosis. One hundred and fifty-six patients (59.5%) had bacterial infections and 59 patients (22.5%) had viral infections. Viruses were detected in BAL fluid specimens of 37 patients (62.7%, 37/59). The most commonly identified viruses were respiratory syncytial virus and parainfluenza virus (both 27.1%, 16/59), followed by rhinovirus (25.4%, 15/59), and influenza virus (16.9%, 10/59). Twenty-one patients (8.0%, 21/262) had bacterial-viral coinfections and Staphylococcus aureus was the most commonly coexisting bacteria (n = 10). Viral infection in non-immunocompromised patients was not uncommon (11.1%, 16/143), although it was not as frequent as that in immunocompromised patients (36.4%, 43/119). Non-immunocompromised patients were significantly older than immunocompromised patients and had significantly higher rates of underlying chronic obstructive pulmonary disease, tuberculous destroyed lung and chronic kidney disease. The 28 day mortalities of patients with bacterial infections, viral infections and bacterial-viral coinfections were not significantly different (29.5%, 35.6% and 19.0%, respectively; p = 0.321).ConclusionsViral pathogens are not uncommon in adult patients with severe HAP who required ICU admission. Since viral pathogens may cause severe HAP and could be a potential source of viral transmission, further investigation is required to delineate the role of viral pathogens in severe HAP.
Highlights
Hospital-acquired pneumonia (HAP) is the second most common nosocomial infection, and severe hospital-acquired pneumonia (HAP) requiring treatment in the intensive care unit (ICU) is associated with high morbidity and mortality [1,2]
Several previous investigators reported on the role of respiratory viruses, those studies were mainly confined to patients with hematologic malignancy [6], or hematopoietic stem cell or solid organ transplant recipients [7,8,9,10,11,12,13]
Using multiplex reverse-transcription polymerase chain reaction (PCR) methods, we previously showed that viral infection is as common as bacterial infection in adult patients from the community with severe pneumonia requiring ICU admission [23]
Summary
Hospital-acquired pneumonia (HAP) is the second most common nosocomial infection, and severe HAP requiring treatment in the intensive care unit (ICU) is associated with high morbidity and mortality [1,2]. Several previous investigators reported on the role of respiratory viruses, those studies were mainly confined to patients with hematologic malignancy [6], or hematopoietic stem cell or solid organ transplant recipients [7,8,9,10,11,12,13]. These studies included both upper respiratory tract infections and lower respiratory tract infections, and did not distinguish between hospital-acquired and community-acquired infections. We investigated the role and distribution of viruses in adult with severe HAP who required intensive care
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