Impact of respiratory viruses in hospital-acquired pneumonia in the intensive care unit: A single-center retrospective study

doi:10.1016/j.jcv.2017.04.001

. 2017 Jun:91:52-57.

doi: 10.1016/j.jcv.2017.04.001. Epub 2017 Apr 22.

Impact of respiratory viruses in hospital-acquired pneumonia in the intensive care unit: A single-center retrospective study

Affiliations

¹ IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, AP-HP, Paris, France. Electronic address: paul.loubet@aphp.fr.
² AP-HP, Hôpital Bichat-Claude Bernard, Service de réanimation médicale et infectieuse, F-75018 Paris, France.
³ AP-HP, Hôpital Bichat-Claude Bernard, Laboratoire de Virologie, F-75018 Paris, France.
⁴ IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Service de réanimation médicale et infectieuse, Hôpital Bichat, AP-HP, Paris, France.
⁵ IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, AP-HP, Paris, France.
⁶ IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France.

PMID: 28494435
PMCID: PMC7106511
DOI: 10.1016/j.jcv.2017.04.001

Impact of respiratory viruses in hospital-acquired pneumonia in the intensive care unit: A single-center retrospective study

Paul Loubet et al. J Clin Virol. 2017 Jun.

. 2017 Jun:91:52-57.

doi: 10.1016/j.jcv.2017.04.001. Epub 2017 Apr 22.

Affiliations

¹ IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, AP-HP, Paris, France. Electronic address: paul.loubet@aphp.fr.
² AP-HP, Hôpital Bichat-Claude Bernard, Service de réanimation médicale et infectieuse, F-75018 Paris, France.
³ AP-HP, Hôpital Bichat-Claude Bernard, Laboratoire de Virologie, F-75018 Paris, France.
⁴ IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Service de réanimation médicale et infectieuse, Hôpital Bichat, AP-HP, Paris, France.
⁵ IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, AP-HP, Paris, France.
⁶ IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France.

PMID: 28494435
PMCID: PMC7106511
DOI: 10.1016/j.jcv.2017.04.001

Abstract

Background: Data on the frequency and role of respiratory viruses (RVs) in hospital-acquired pneumonia (HAP) are still scarce.

Objectives: We assessed the proportion of RVs and their impact on the outcome of hospital-acquired pneumonia (HAP) in the intensive care unit (ICU).

Study design: Cases of HAP were retrospectively selected among patients who underwent screening for RVs by multiplex PCR (mPCR) in the ICU of a French tertiary care hospital from May 2014 to April 2016. ICU length of stay and in-hospital mortality were compared between four groups defined according to the identified pathogens: virus only (V), virus/bacteria (V/B), bacteria only (B) and no pathogen (Neg). When available, previous mPCR was retrieved in order to assess possible chronic viral carriage.

Results: Overall, 95/999 (10%) ICU patients who underwent mPCR had HAP (V(17,18%), V/B(13,14%), B(60,63%), Neg(5,5%)). Median age was 61 years and 45 (47%) were immunocompromised. Influenza (27%) and rhinovirus (27%) were the most common RVs. V/B group had higher mortality rate than B and V groups (62% vs. 40% and 35%, p=0.3) and a significantly longer length of stay (31days (18-48)) than V group (5days (3-11), p=0.0002)) and B group (14.5days (5.5-25.5), p=0.007)). Among the 15 patients with available mPCR tests before viral HAP, seven were negative and eight were positive corresponding to long-term carriage of community-acquired viruses.

Discussion: RVs were detected in 32% of HAP patients who underwent mPCR. Two situations were encountered: (i) acute acquired viral infection; (ii) long-term viral carriage (mostly rhinovirus) especially in immunocompromised patients complicated by a virus/bacteria coinfection. The latter was associated with a longer length of stay and a trend toward a higher mortality.

Keywords: Hospital-acquired pneumonia; Intensive care unit; Nosocomial; Pneumonia; Respiratory virus.

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Figures

**Fig. 1**
Distribution of respiratory viruses in patients with mPCR testing before HAP diagnosis. RV: respiratory virus, mPCR: multiplex polymerase chain reaction; VAP: ventilator-acquired pneumonia; MSSA: methicillin-sensitive *Staphylococcus aureus*.

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References

1. Lieberman D., Shimoni A., Shemer-Avni Y., Keren-Naos A., Shtainberg R., Lieberman D. Respiratory viruses in adults with community-acquired pneumonia. Chest. 2010;138:811–816. - PMC - PubMed
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[1] Lieberman D., Shimoni A., Shemer-Avni Y., Keren-Naos A., Shtainberg R., Lieberman D. Respiratory viruses in adults with community-acquired pneumonia. Chest. 2010;138:811–816. - PMC - PubMed

[2] Lieberman D., Shimoni A., Shemer-Avni Y., Keren-Naos A., Shtainberg R., Lieberman D. Respiratory viruses in adults with community-acquired pneumonia. Chest. 2010;138:811–816. - PMC - PubMed

[3] Jennings L.C., Anderson T.P., Beynon K.A., Chua A., Laing R.T.R., Werno A.M. Incidence and characteristics of viral community-acquired pneumonia in adults. Thorax. 2008;63:42–48. - PubMed

[4] Jennings L.C., Anderson T.P., Beynon K.A., Chua A., Laing R.T.R., Werno A.M. Incidence and characteristics of viral community-acquired pneumonia in adults. Thorax. 2008;63:42–48. - PubMed

[5] Jain S., Self W.H., Wunderink R.G., Fakhran S., Balk R., Bramley A.M. Community-acquired pneumonia requiring hospitalization among U.S. adults. N. Engl. J. Med. 2015;373:415–427. - PMC - PubMed

[6] Jain S., Self W.H., Wunderink R.G., Fakhran S., Balk R., Bramley A.M. Community-acquired pneumonia requiring hospitalization among U.S. adults. N. Engl. J. Med. 2015;373:415–427. - PMC - PubMed

[7] Das D., Le Floch H., Houhou N., Epelboin L., Hausfater P., Khalil A. Viruses detected by systematic multiplex polymerase chain reaction in adults with suspected community-acquired pneumonia attending emergency departments in France. Clin. Microbiol. Infect. 2015;21:608. e1–e8. - PMC - PubMed

[8] Das D., Le Floch H., Houhou N., Epelboin L., Hausfater P., Khalil A. Viruses detected by systematic multiplex polymerase chain reaction in adults with suspected community-acquired pneumonia attending emergency departments in France. Clin. Microbiol. Infect. 2015;21:608. e1–e8. - PMC - PubMed

[9] Weigt S.S., Gregson A.L., Deng J.C., Lynch J.P., Belperio J.A. Respiratory viral infections in hematopoietic stem cell and solid organ transplant recipients. Semin. Respir. Crit. Care Med. 2011;32:471–493. - PMC - PubMed

[10] Weigt S.S., Gregson A.L., Deng J.C., Lynch J.P., Belperio J.A. Respiratory viral infections in hematopoietic stem cell and solid organ transplant recipients. Semin. Respir. Crit. Care Med. 2011;32:471–493. - PMC - PubMed

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Impact of respiratory viruses in hospital-acquired pneumonia in the intensive care unit: A single-center retrospective study

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Impact of respiratory viruses in hospital-acquired pneumonia in the intensive care unit: A single-center retrospective study

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