Viral-bacterial coinfection affects the presentation and alters the prognosis of severe community-acquired pneumonia.
Crit Care
; 20(1): 375, 2016 Oct 25.
Article
en En
| MEDLINE
| ID: mdl-27852281
ABSTRACT
BACKGROUND:
Multiplex polymerase chain reaction (mPCR) enables recovery of viruses from airways of patients with community-acquired pneumonia (CAP), although their clinical impact remains uncertain.METHODS:
Among 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.RESULTS:
Among 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.CONCLUSIONS:
Viral-bacterial coinfection during severe CAP in adults is associated with an impaired presentation and a complicated course.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Neumonía Viral
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Índice de Severidad de la Enfermedad
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Infecciones Comunitarias Adquiridas
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Neumonía Bacteriana
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Coinfección
Tipo de estudio:
Observational_studies
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Prognostic_studies
/
Risk_factors_studies
Límite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Crit Care
Año:
2016
Tipo del documento:
Article
País de afiliación:
Francia