title: Viruses are prevalent in non-ventilated hospital-acquired pneumonia.
abstract: Hospital-acquired pneumonia arising in non-ventilated patients (NVHAP) is traditionally thought to be caused by bacteria, and little is known about viral etiologies in this syndrome. We sought to describe the prevalence of viruses causing NVHAP and to determine factors independently associated with the isolation of a virus.
  
  
  
  We identified patients with NVHAP over one year and reviewed their cultures to determine etiologies. Patients with a viral process were compared to those with either negative cultures or a bacterial infection to determine variables independently associated with the recovery of a virus.
  
  
  
  Among 174 cases, cultures were positive in 46.0%, with viruses identified in 22.4%. Bacterial pathogens arose 23.6% of subjects. The most common viruses included rhinovirus, influenza, and parainfluenza. We noted no seasonality in the isolation of viral organisms, and most cases of viral NVHAP developed after more than a week length of stay (LOS). Outcomes in viral NVHAP were similar to those with bacterial NVHAP. Patients with viral and bacterial NVHAP were generally similar. Two variables were independently associated with isolation of a virus: a history of coronary artery disease (adjusted odds ratio: 5.16, 95% CI: 1.14-22.44) and a LOS of greater than 10 days prior to NVHAP diagnosis (adjusted odds ratio: 2.97, 95% CI: 1.35-6.51). As a screening test for a virus, neither had a good sensitivity or specificity.
  
  
  
  Viruses represent a common cause of NVHAP. Clinicians should consider viral diagnostic testing in NVHAP, as this may represent a means to enhance antimicrobial stewardship.
authors.affiliation: Pulmonary and Critical Care Medicine Service, Medstar Washington Hospital Center, Washington, DC, United States. Electronic address: Andrew.shorr@gmail.com.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Shorr
authors.affiliation: Evimed Research, Goshen, MA, United States.
authors.forename: Marya D
authors.initials: MD
authors.lastname: Zilberberg
authors.affiliation: St. Louis College of Pharmacy, St. Louis, MO, United States.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Micek
authors.affiliation: The Division of Pulmonary and Critical Care Medicine, Barnes Jewish Christian Hospital, St. Louis, MO, United States.
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
mesh_terms: D000328:Adult; D000368:Aged; D001419:Bacteria / Q000302:isolation & purification; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology*; D005260:Female; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology / Q000821:virology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018184:Paramyxoviridae Infections / Q000453:epidemiology / Q000821:virology; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D011024:Pneumonia, Viral / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology*; D015995:Prevalence; D012121:Respiration, Artificial / Q000706:statistics & numerical data / Q000639:trends*; D012189:Retrospective Studies; D012229:Rhinovirus / Q000302:isolation & purification; D016896:Treatment Outcome; D014780:Viruses / Q000302:isolation & purification* / Q000472:pathogenicity
keywords: Bacteria; Hospital; Outcomes; Pneumonia; Virus