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Multicenter Study
. 2019 Feb:60:54-70.
doi: 10.1016/j.ejim.2018.10.020. Epub 2018 Nov 4.

An international perspective on hospitalized patients with viral community-acquired pneumonia

Dejan Radovanovic  1 , Giovanni Sotgiu  2 , Mateja Jankovic  3 , Padukudru Anand Mahesh  4 , Pedro Jorge Marcos  5 , Mohamed I Abdalla  6 , Marta Francesca Di Pasquale  7 , Andrea Gramegna  7 , Silvia Terraneo  8 , Francesco Blasi  7 , Pierachille Santus  1 , Stefano Aliberti  9 , Luis F Reyes  10 , Marcos I Restrepo  6 ; GLIMP Study Group
Collaborators, Affiliations
Multicenter Study

An international perspective on hospitalized patients with viral community-acquired pneumonia

Dejan Radovanovic et al. Eur J Intern Med. 2019 Feb.

Abstract

Background: Who should be tested for viruses in patients with community acquired pneumonia (CAP), prevalence and risk factors for viral CAP are still debated. We evaluated the frequency of viral testing, virus prevalence, risk factors and treatment coverage with oseltamivir in patients admitted for CAP.

Methods: Secondary analysis of GLIMP, an international, multicenter, point-prevalence study of hospitalized adults with CAP. Testing frequency, prevalence of viral CAP and treatment with oseltamivir were assessed among patients who underwent a viral swab. Univariate and multivariate analysis was used to evaluate risk factors.

Results: 553 (14.9%) patients with CAP underwent nasal swab. Viral CAP was diagnosed in 157 (28.4%) patients. Influenza virus was isolated in 80.9% of cases. Testing frequency and viral CAP prevalence were inhomogeneous across the participating centers. Obesity (OR 1.59, 95%CI: 1.01-2.48; p = 0.043) and need for invasive mechanical ventilation (OR 1.62, 95%CI: 1.02-2.56; p = 0.040) were independently associated with viral CAP. Prevalence of empirical treatment with oseltamivir was 5.1%.

Conclusion: In an international scenario, testing frequency for viruses in CAP is very low. The most common cause of viral CAP is Influenza virus. Obesity and need for invasive ventilation represent independent risk factors for viral CAP. Adherence to recommendations for treatment with oseltamivir is poor.

Keywords: Community acquired pneumonia; Influenza; Oseltamivir; Testing; Viral pneumonia; Viral swab.

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Figures

Fig. 1
Fig. 1
Flow chart describing the study samples.
Fig. 2
Fig. 2
Frequency of testing for viruses as a percentage of all tests performed in each country and prevalence of viral CAP as a percentage of all the viral swabs performed in each country. The size of each sphere indicates the number of patients with CAP enrolled in the GLIMP sample. Only countries with >20 patients enrolled are shown, excepted for United Arab Emirates, China and Austria that had a high frequency of testing despite the lower number of patients enrolled.
Fig. 3
Fig. 3
Prevalence of influenza virus CAP (red area) in relation to all cause viral CAP (blue area). The ratio between swabs positive for influenza compared to all positive swabs by each country is reported in the left sided vertical axis. Absolute patients enrolled in the study (grey area) are reported in the right sided vertical axis. Only countries that have performed at least one viral swab are shown. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 4
Fig. 4
Prevalence of empiric treatment with oseltamivir among patients tested with a viral swab. Blue areas represent negative swabs, while grey areas represent swabs positive for either Influenza virus (light grey) or all other viruses (dark grey). For every area, the striped part indicates the percentage of patients empirically covered with oseltamivir. Pos = positive; neg = negative. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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