Viral Infection in Patients with Severe Pneumonia Requiring Intensive Care Unit Admission

被引:254
作者
Choi, Sang-Ho [2 ]
Hong, Sang-Bum [1 ]
Ko, Gwang-Beom [2 ]
Lee, Yumi [2 ]
Park, Hyun Jung [2 ]
Park, So-Youn [2 ]
Moon, Song Mi [2 ]
Cho, Oh-Hyun [2 ]
Park, Ki-Ho [2 ]
Chong, Yong Pil [2 ]
Kim, Sung-Han [2 ]
Huh, Jin Won [1 ]
Sung, Heungsup [3 ]
Do, Kyung-Hyun [4 ]
Lee, Sang-Oh [2 ]
Kim, Mi-Na [3 ]
Jeong, Jin-Yong [2 ,5 ]
Lim, Chae-Man [1 ]
Kim, Yang Soo [2 ]
Woo, Jun Hee [2 ]
Koh, Younsuck [1 ]
机构
[1] Univ Ulsan, Coll Med, Asan Med Ctr, Dept Pulm & Crit Care Med, Seoul, South Korea
[2] Univ Ulsan, Coll Med, Asan Med Ctr, Dept Infect Dis, Seoul, South Korea
[3] Univ Ulsan, Coll Med, Asan Med Ctr, Dept Lab Med, Seoul, South Korea
[4] Univ Ulsan, Coll Med, Asan Med Ctr, Dept Radiol, Seoul, South Korea
[5] Univ Ulsan, Coll Med, Asan Med Ctr, Asan Inst Life Sci, Seoul, South Korea
关键词
pneumonia; viral pneumonia; bronchoalveolar lavage; intensive care units; rhinovirus; COMMUNITY-ACQUIRED PNEUMONIA; RESPIRATORY VIRUSES; STREPTOCOCCUS-PNEUMONIAE; HOSPITALIZED-PATIENTS; BACTERIAL PNEUMONIA; ETIOLOGY; TIME; PATHOGENS; RHINOVIRUSES;
D O I
10.1164/rccm.201112-2240OC
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Rationale: The role of viruses in pneumonia in adults and the impact of viral infection on mortality have not been elucidated. Previous studies have significant limitations in that they relied predominantly on upper respiratory specimens. Objectives: To investigate the role of viral infection in adult patients with pneumonia requiring intensive care unit (ICU) admission. Methods: A retrospective analysis of a prospective cohort was conducted in a 28-bed medical ICU. Patients with severe community-acquired pneumonia (CAP) or healthcare-associated pneumonia (HCAP) were included in the study. Measurements and Main Results: A total of 198 patients (64 with CAP, 134 with HCAP) were included for analysis. Of these, 115 patients (58.1%) underwent bronchoscopic bronchoalveolar lavage (BAL), 104 of whom were tested for respiratory viruses by BAL fluid reverse-transcription polymerase chain reaction (RT-PCR). Nasopharyngeal specimen RT-PCR was performed in 159 patients (84.1%). Seventy-one patients (35.9%) had a bacterial infection, and 72 patients (36.4%) had a viral infection. Rhinovirus was the most common identified virus (23.6%), followed by parainfluenza virus (20.8%), human metapneumovirus (18.1%), influenza virus (16.7%), and respiratory syncytial virus (13.9%). Respiratory syncytial virus was significantly more common in the CAP group (CAP, 10.9%; HCAP, 2.2%; P = 0.01). The mortalities of patients with bacterial infections, viral infections, and bacterial-viral coinfections were not significantly different (25.5, 26.5, and 33.3%, respectively; P = 0.82). Conclusions: Viruses are frequently found in the airway of patients with pneumonia requiring ICU admission and may cause severe forms of pneumonia. Patients with viral infection and bacterial infection had comparable mortality rates.
引用
收藏
页码:325 / 332
页数:8
相关论文
共 39 条
[11]   Community-acquired polymicrobial pneumonia in the intensive care unit: aetiology and prognosis [J].
Cilloniz, Catia ;
Ewig, Santiago ;
Ferrer, Miquel ;
Polverino, Eva ;
Gabarrus, Albert ;
de la Bellacasa, Jorge Puig ;
Mensa, Josep ;
Torres, Antoni .
CRITICAL CARE, 2011, 15 (05)
[12]   Detection of respiratory viruses and Legionella spp. by real-time polymerase chain reaction in patients with community acquired pneumonia [J].
Diederen, Bram M. W. ;
Van Der Eerden, Menno M. ;
Vlaspolder, Fer ;
Boersma, Wim G. ;
Kluytmans, Jan A. J. W. ;
Peeters, Marcel F. .
SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES, 2009, 41 (01) :45-50
[13]   Fatal hemorrhagic pneumonia caused by human metapneumovirus in an immunocompetent child [J].
Donoso, Alejandro F. ;
Leon, Jose A. ;
Camacho, Jorge F. ;
Cruces, Pablo I. ;
Ferres, Marcela .
PEDIATRICS INTERNATIONAL, 2008, 50 (04) :589-591
[14]   A prediction rule to identify low-risk patients with community-acquired pneumonia [J].
Fine, MJ ;
Auble, TE ;
Yealy, DM ;
Hanusa, BH ;
Weissfeld, LA ;
Singer, DE ;
Coley, CM ;
Marrie, TJ ;
Kapoor, WN .
NEW ENGLAND JOURNAL OF MEDICINE, 1997, 336 (04) :243-250
[15]   Respiratory viruses in bronchoalveolar lavage: a hospital-based cohort study in adults [J].
Garbino, J. ;
Soccal, P. M. ;
Aubert, J-D ;
Rochat, T. ;
Meylan, P. ;
Thomas, Y. ;
Tapparel, C. ;
Bridevaux, P-O ;
Kaiser, L. .
THORAX, 2009, 64 (05) :399-404
[16]   Evaluation of multiple commercial molecular and conventional diagnostic assays for the detection of respiratory viruses in children [J].
Gharabaghi, F. ;
Hawan, A. ;
Drews, S. J. ;
Richardson, S. E. .
CLINICAL MICROBIOLOGY AND INFECTION, 2011, 17 (12) :1900-1906
[17]  
Hohenthal U, 2008, THORAX, V63, P658
[18]   Pneumonia caused by rhinovirus [J].
Imakita, M ;
Shiraki, K ;
Yutani, C ;
Ishibashi-Ueda, H .
CLINICAL INFECTIOUS DISEASES, 2000, 30 (03) :611-612
[19]   Effects of rhinovirus infection on the adherence of Streptococcus pneumoniae to cultured human airway epithelial cells [J].
Ishizuka, S ;
Yamaya, M ;
Suzuki, T ;
Takahashi, H ;
Ida, S ;
Sasaki, T ;
Inoue, D ;
Sekizawa, K ;
Nishimura, H ;
Sasaki, H .
JOURNAL OF INFECTIOUS DISEASES, 2003, 188 (12) :1928-1939
[20]   Incidence and characteristics of viral community-acquired pneumonia in adults [J].
Jennings, L. C. ;
Anderson, T. P. ;
Beynon, K. A. ;
Chua, A. ;
Laing, R. T. R. ;
Werno, A. M. ;
Young, S. A. ;
Chambers, S. T. ;
Murdoch, D. R. .
THORAX, 2008, 63 (01) :42-48