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

Critical Care, Oct 2016

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.

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

Voiriot et al. Critical Care Viral-bacterial coinfection affects the presentation and alters the prognosis of severe community-acquired pneumonia Guillaume Voiriot 0 1 4 5 Benoit Visseaux 3 Johana Cohen 0 4 Liem Binh Luong Nguyen 2 Mathilde Neuville 0 4 Caroline Morbieu 2 Charles Burdet 2 Aguila Radjou 0 4 François-Xavier Lescure 2 Roland Smonig 0 4 Laurence Armand-Lefèvre 8 Bruno Mourvillier 0 4 Yazdan Yazdanpanah 2 7 Jean-Francois Soubirou 0 4 Stephane Ruckly 6 Nadhira Houhou-Fidouh 3 Jean-François Timsit 0 4 7 0 Service de Réanimation Médicale et Infectieuse, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique - Hôpitaux de Paris (AP-HP) , Paris , France 1 Hôpital Bichat Claude Bernard , 46 rue Henri Huchard, Paris 75018 , France 2 Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique - Hôpitaux de Paris (AP-HP) , Paris , France 3 Service de Virologie, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique - Hôpitaux de Paris (AP-HP) , Paris , France 4 Service de Réanimation Médicale et Infectieuse, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique - Hôpitaux de Paris (AP-HP) , Paris , France 5 Hôpital Bichat Claude Bernard , 46 rue Henri Huchard, Paris 75018 , France 6 Université de Grenoble 1, Center U823 Epidemioloy of Cancers and Severe Diseases , La Tronche , France 7 Université Paris Diderot-Paris VII , Paris , France 8 Service de Microbiologie, Hôpital Bichat Claude Bernard, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique - Hôpitaux de Paris (AP-HP) , Paris , France 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. Pneumonia; Viral pneumonia; Respiratory viruses; Intensive care - Background 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; however, the causative role of respiratory viruses emerged recently [2]. Multiplex polymerase chain reaction (mPCR) kits screen a large panel of respiratory viruses, and nowadays are available in clinical practice. They were used within several studies among adult ICU patients with CAP [3–6]. High rates of positivity were reported, up to 49 % [4], with strong variations in the distribution of viral species according to the population, the season, and the geographic area. However, the causative role of respiratory viruses identified in the respiratory tract during pneumonia is still debatable, since respiratory viruses might be present in asymptomatic adult subjects [7, 8]. Some experimental data focusing on virus-bacteria interactions during respiratory © 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public (...truncated)


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Guillaume Voiriot, Benoit Visseaux, Johana Cohen, Liem Nguyen, Mathilde Neuville, Caroline Morbieu, Charles Burdet, Aguila Radjou, François-Xavier Lescure, Roland Smonig, Laurence Armand-Lefèvre, Bruno Mourvillier, Yazdan Yazdanpanah, Jean-Francois Soubirou, Stephane Ruckly, Nadhira Houhou-Fidouh, Jean-François Timsit. Viral-bacterial coinfection affects the presentation and alters the prognosis of severe community-acquired pneumonia, Critical Care, 2016, pp. 375, 20, DOI: 10.1186/s13054-016-1517-9