title: Viral-bacterial coinfection affects the presentation and alters the prognosis of severe community-acquired pneumonia.
abstract: BACKGROUND
  Multiplex polymerase chain reaction (mPCR) enables recovery of viruses from airways of patients with community-acquired pneumonia (CAP), although their clinical impact remains uncertain.
  
  
  METHODS
  Among consecutive adult patients who had undergone a mPCR within 72 hours following their admission to one intensive care unit (ICU), we retrospectively included those with a final diagnosis of CAP. Four etiology groups were clustered: bacterial, viral, mixed (viral-bacterial) and no etiology. A composite criterion of complicated course (hospital death or mechanical ventilation > 7 days) was used. A subgroup analysis compared patients with bacterial and viral-bacterial CAP matched on the bacterial pathogens.
  
  
  RESULTS
  Among 174 patients (132 men [76 %], age 63 [53-75] years, SAPSII 38 [27;55], median PSI score 106 [78;130]), bacterial, viral, mixed and no etiology groups gathered 46 (26 %), 53 (31 %), 45 (26 %) and 30 (17 %) patients, respectively. Virus-infected patients displayed a high creatine kinase serum level, a low platelet count, and a trend toward more frequent alveolar-interstitial infiltrates. A complicated course was more frequent in the mixed group (31/45, 69 %), as compared to bacterial (18/46, 39 %), viral (15/53, 28 %) and no etiology (12/30, 40 %) groups (p < 0.01). In multivariate analysis, the mixed (viral-bacterial) infection was independently associated with complicated course (reference: bacterial pneumonia; OR, 3.58; CI 95 %, 1.16-11; p = 0.03). The subgroup analysis of bacteria-matched patients confirmed these findings.
  
  
  CONCLUSIONS
  Viral-bacterial coinfection during severe CAP in adults is associated with an impaired presentation and a complicated course.
authors.affiliation: Service de Réanimation Médicale et Infectieuse, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France. guillaume.voiriot@aphp.fr.|Hôpital Bichat Claude Bernard, 46 rue Henri Huchard, Paris, 75018, France. guillaume.voiriot@aphp.fr.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Voiriot
authors.affiliation: Service de Virologie, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Visseaux
authors.affiliation: Service de Réanimation Médicale et Infectieuse, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: Johana
authors.initials: J
authors.lastname: Cohen
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: Liem Binh Luong
authors.initials: LB
authors.lastname: Nguyen
authors.affiliation: Service de Réanimation Médicale et Infectieuse, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Neuville
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Morbieu
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Burdet
authors.affiliation: Service de Réanimation Médicale et Infectieuse, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: Aguila
authors.initials: A
authors.lastname: Radjou
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Lescure
authors.affiliation: Service de Réanimation Médicale et Infectieuse, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: Roland
authors.initials: R
authors.lastname: Smonig
authors.affiliation: Service de Microbiologie, Hôpital Bichat Claude Bernard, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Armand-Lefèvre
authors.affiliation: Service de Réanimation Médicale et Infectieuse, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Mourvillier
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.|Université Paris Diderot-Paris VII, Paris, France.
authors.forename: Yazdan
authors.initials: Y
authors.lastname: Yazdanpanah
authors.affiliation: Service de Réanimation Médicale et Infectieuse, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Soubirou
authors.affiliation: Université de Grenoble 1, Center U823 Epidemioloy of Cancers and Severe Diseases, La Tronche, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Ruckly
authors.affiliation: Service de Virologie, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: Nadhira
authors.initials: N
authors.lastname: Houhou-Fidouh
authors.affiliation: Service de Réanimation Médicale et Infectieuse, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.|Université Paris Diderot-Paris VII, Paris, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
mesh_terms: D000368:Aged; D060085:Coinfection / Q000175:diagnosis* / Q000453:epidemiology; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000639:trends; D008297:Male; D008875:Middle Aged; D060885:Multiplex Polymerase Chain Reaction / Q000379:methods; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000453:epidemiology; D011024:Pneumonia, Viral / Q000175:diagnosis* / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Intensive care; Pneumonia; Respiratory viruses; Viral pneumonia