title: Impact of preceding respiratory viral infections on the clinical severity of patients with pneumococcal pneumonia.
abstract: BACKGROUND
  This study aimed to investigate the impact of preceding respiratory viral infections (RVI) on the clinical severity of pneumococcal pneumonia patients.
  
  
  METHODS
  A retrospective observational study was conducted at a university hospital from January 2009 to March 2013. Study subjects included adults (aged ≥18 years) with pneumococcal pneumonia who had undergone laboratory tests for RVI. Multivariate logistic regression analysis was performed to identify risk factors associated with severe pneumococcal pneumonia, defined as severity with the Pneumonia Severity Index (PSI) score ≥91.
  
  
  RESULTS
  In total, 191 patients with pneumococcal pneumonia were included for analysis and stratified into 2 groups: the severe group with a PSI score ≥91 (n = 99) and the non-severe group with a PSI score <91 (n = 92). Preceding RVIs were detected in 48 patients, including influenza A virus (n = 20), influenza B virus (n = 4), parainfluenza viruses (n = 5), metapneumovirus (n = 4), rhinovirus (n = 4), respiratory syncytial viruses (n = 6), coronaviruses (n = 2), and mixed viral infections (n = 3). In the multivariate logistic regression analysis, preceding RVIs (odds ratio [OR], 2.49; 95% confidence interval [CI], 1.10-5.60), male sex (OR, 2.58; 95% CI, 1.24-5.38), old age (OR, 2.92; 95% CI, 1.37-6.24), hypoalbuminemia (OR, 3.26; 95% CI, 1.56-6.84)], and azotemia (OR, 2.24; 95% CI, 1.08-4.67) were significantly associated with severe pneumococcal pneumonia.
  
  
  CONCLUSIONS
  This study suggests that preceding RVIs might be one of the risk factors affecting the clinical severity of pneumococcal pneumonia.
authors: Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea; Institute of Emerging Infectious Diseases, Korea University College of Medicine, Seoul, Korea.
authors: Young Kyung
authors: YK
authors: Yoon
authors: Kyung Sook
authors: KS
authors: Yang
authors: Jang Wook
authors: JW
authors: Sohn
authors: Chang Kyu
authors: CK
authors: Lee
authors: Min Ja
authors: MJ
authors: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011018:Pneumonia, Pneumococcal / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D012141:Respiratory Tract Infections / Q000821:virology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000502:physiology; D014780:Viruses / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Clinical severity; Streptococcus pneumoniae; pneumonia; respiratory viruses