title: Lower respiratory tract virus findings in mechanically ventilated patients with severe community-acquired pneumonia.
abstract: BACKGROUND
  The role of viral infections in the etiology of severe community-acquired pneumonia (SCAP) was prospectively evaluated from 2008 to 2012 at a university-level intensive care unit.
  
  
  METHODS
  Clinical data and microbiological tests were assessed: blood cultures, urine pneumococcal and legionella antigens, Mycoplasma pneumoniae and Chlamydia pneumoniae antibodies from paired serums, and respiratory virus detection by multiplex, real-time polymerase chain reaction (PCR) from nasopharyngeal swabs and lower tracheal specimens via intubation tube.
  
  
  RESULTS
  Of 49 mechanically ventilated SCAP patients (21 men and 28 women; median age, 54 years), the etiology was identified in 45 cases (92%). There were 21 pure bacterial infections (43%), 5 probably pure viral infections (10%), and 19 mixed bacterial-viral infections (39%), resulting in viral etiology in 24 patients (49%). Of 26 viruses, 21 (81%) were detected from bronchial specimens and 5 (19%) from nasopharyngeal swabs. Rhinovirus (15 cases, 58%) and adenovirus (4 cases, 15%) were the most common viral findings. The bacterial-viral etiology group had the highest peak C-reactive protein levels (median, 356 [25th-75th percentiles, 294-416], P = .05), whereas patients with probably viral etiology had the lowest peak procalcitonin levels (1.7 [25th-75th percentiles, 1.6-1.7]). The clinical characteristics of pure bacterial and mixed bacterial-viral etiologies were comparable. Hospital stay was longest among the bacterial group (17 vs 14 days; P = .02).
  
  
  CONCLUSIONS
  Viral findings were demonstrated in almost half of the SCAP patients. Clinical characteristics were similar between the pure bacterial and mixed bacterial-viral infections groups. The frequency of viral detection depends on the availability of PCR techniques and lower respiratory specimens.
authors.affiliation: Department of Anaesthesiology, Division of Intensive Care.
authors.forename: J
authors.initials: J
authors.lastname: Karhu
authors.affiliation: Department of Anaesthesiology, Division of Intensive Care.
authors.forename: T I
authors.initials: TI
authors.lastname: Ala-Kokko
authors.affiliation: Department of Virology, University of Turku, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Vuorinen
authors.affiliation: Department of Anaesthesiology and Surgery.
authors.forename: P
authors.initials: P
authors.lastname: Ohtonen
authors.affiliation: Department of Infection Control, Oulu University Hospital, Medical Research Center Oulu.
authors.forename: H
authors.initials: H
authors.lastname: Syrjälä
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000473:pathology / Q000821:virology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060885:Multiplex Polymerase Chain Reaction; D011024:Pneumonia, Viral / Q000453:epidemiology* / Q000473:pathology / Q000821:virology*; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D012121:Respiration, Artificial; D014780:Viruses / Q000145:classification* / Q000302:isolation & purification*; D055815:Young Adult
keywords: etiology; intensive care; severe community-acquired pneumonia; viral infection
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