title: Epidemiology, Co-Infections, and Outcomes of Viral Pneumonia in Adults: An Observational Cohort Study.
abstract: Advanced technologies using polymerase-chain reaction have allowed for increased recognition of viral respiratory infections including pneumonia. Co-infections have been described for several respiratory viruses, especially with influenza. Outcomes of viral pneumonia, including cases with co-infections, have not been well described. This was observational cohort study conducted to describe hospitalized patients with viral pneumonia including co-infections, clinical outcomes, and predictors of mortality. Patients admitted from March 2013 to November 2014 with a positive respiratory virus panel (RVP) and radiographic findings of pneumonia within 48  h of the index RVP were included. Co-respiratory infection (CRI) was defined as any organism identification from a respiratory specimen within 3 days of the index RVP. Predictors of in-hospital mortality on univariate analysis were evaluated in a multivariate model. Of 284 patients with viral pneumonia, a majority (51.8%) were immunocompromised. A total of 84 patients (29.6%) were found to have a CRI with 48 (57.6%) having a bacterial CRI. Viral CRI with HSV, CMV, or both occurred in 28 patients (33.3%). Fungal (16.7%) and other CRIs (7.1%) were less common. Many patients required mechanical ventilation (54%) and vasopressor support (36%). Overall in-hospital mortality was high (23.2%) and readmissions were common with several patients re-hospitalized within 30 (21.1%) and 90 days (36.7%) of discharge. Predictors of in-hospital mortality on multivariate regression included severity of illness factors, stem-cell transplant, and identification of multiple respiratory viruses. In conclusion, hospital mortality is high among adult patients with viral pneumonia and patients with multiple respiratory viruses identified may be at a higher risk.
authors.affiliation: From the Pharmacy St. Louis College of Pharmacy (STLCOP) (MPC); STLCOP and Dept of Pharmacy, Barnes-Jewish Hospital (DJR); STLCOP (SM); STLCOP and Dept of Pharmacy, Barnes-Jewish Hospital (STM); Center for Clinical Excellence, BJC Healthcare (NH); Department of Pediatrics, Washington University School of Medicine (RSB, GAS); and Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine (MHK).
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Crotty
authors.forename: Shelby
authors.initials: S
authors.lastname: Meyers
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hampton
authors.forename: Stephanie
authors.initials: S
authors.lastname: Bledsoe
authors.forename: David J
authors.initials: DJ
authors.lastname: Ritchie
authors.forename: Richard S
authors.initials: RS
authors.lastname: Buller
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Storch
authors.forename: Scott T
authors.initials: ST
authors.lastname: Micek
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D060085:Coinfection / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D003422:Critical Care; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011024:Pneumonia, Viral / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D012307:Risk Factors