Viral infection in patients with severe pneumonia requiring intensive care unit admission.
BACKGROUND
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.


OBJECTIVE
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.


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.
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Sang-Ho
SH
Choi
Sang-Bum
SB
Hong
Gwang-Beom
GB
Ko
Yumi
Y
Lee
Hyun Jung
HJ
Park
So-Youn
SY
Park
Song Mi
SM
Moon
Oh-Hyun
OH
Cho
Ki-Ho
KH
Park
Yong Pil
YP
Chong
Sung-Han
SH
Kim
Jin Won
JW
Huh
Heungsup
H
Sung
Kyung-Hyun
KH
Do
Sang-Oh
SO
Lee
Mi-Na
MN
Kim
Jin-Yong
JY
Jeong
Chae-Man
CM
Lim
Yang Soo
YS
Kim
Jun Hee
JH
Woo
Younsuck
Y
Koh
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000821:virology; D001992:Bronchoalveolar Lavage Fluid / Q000821:virology; D015331:Cohort Studies; D060085:Coinfection / Q000821:virology; D017714:Community-Acquired Infections / Q000821:virology; D003428:Cross Infection / Q000821:virology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009305:Nasopharynx / Q000821:virology; D011014:Pneumonia / Q000821:virology*; D011446:Prospective Studies; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012720:Severity of Illness Index; D016019:Survival Analysis; D014777:Virus Diseases / Q000821:virology*; D055815:Young Adult