Healthcare-Associated Pneumonia: Don't Forget About Respiratory Viruses!

Abstract

Introduction: Healthcare-associated infections are an important cause of morbidity and mortality, are among the most common adverse events in healthcare, and of them, pneumonia is the most commonly reported. Our objective was to evaluate the incidence and clinical outcome of respiratory viruses in hospital-acquired pneumonia (HAP). Methods: This was a prospective cohort study, include patients aged between 0 and 18 who fulfilled Centers for Diseases Control and Prevention (CDC) criteria for HAP. Demographic and clinical data were obtained, and a nasopharyngeal swab specimen was taken for the detection of respiratory viruses. All included patients were monitored until discharge to collect data on the need for mechanical ventilation, intensive care unit (ICU) admission, and mortality. All-cause 30-day mortality was also ascertained. Results: Four thousand three hundred twenty-seven patients were followed for 42,658 patient-days and 5,150 ventilator-days. Eighty-eight patients (2.03%) met the CDC criteria for HAP, 63 patients were included, and clinical and epidemiological characteristics showed no statistically significant differences between patients with virus associated healthcare-associated pneumonia (VAHAP) and those with non-viral healthcare-associated pneumonia (NVHAP). At least one respiratory virus was detected in 65% [95% CI (53–77)] of episodes of HAP, with a single viral pathogen observed in 53.9% and coinfection with 2 viruses in 11.1% of cases. The outcome in terms of ICU admission, mechanical ventilation and the 30-day mortality did not show a significant difference between groups. Conclusions: In two-thirds of the patients a respiratory virus was identified. There was no difference in mortality or the rest of the clinical outcome variables. About half of the patients required mechanical ventilation and 10% died, which emphasizes the importance of considering these pathogens in nosocomial infections, since their identification can influence the decrease in hospital costs and be taken into account in infection control policies.

Oral health status and the etiology and prevention of nonventilator hospital‐associated pneumonia

“…A substantial proportion of nonventilator hospital-associated pneumonia cases have been associated with viral infections, including rhinovirus, influenza, and parainfluenza. 38,39 Thus, the potential etiologic agents for pneumonia are reported to be numerous and quite heterogeneous between one study and another, and between one individual and another. Because the mouth harbors a wide variety of microbes, it follows that the oral cavity is an important source of the microbes that can enter the lung and cause infection.…”

“…A substantial proportion of nonventilator hospital‐associated pneumonia cases have been associated with viral infections, including rhinovirus, influenza, and parainfluenza 38,39 . Thus, the potential etiologic agents for pneumonia are reported to be numerous and quite heterogeneous between one study and another, and between one individual and another.…”

Modern approaches to pharmacotherapy of Community-Acquired Pneumonia

“…In Australia, CAP costs are estimated at over 300 million annually; and the number of CAP hospitalizations is more than that in any other disease -61 000 hospitalizations per year (Sweeney 2019). Significant economic costs are often caused by adverse outcomes for hospitalized patients, such as loss of respiratory function and, as a result, the need for artificial pulmonary ventilation, high incidence of nosocomial adverse events (risk of developing nosocomial infections, vascular complications) (Torres-García et al 2019).…”

“…Environmental effects in CAP development should be highlighted. A number of studies reported that traffic-related air pollution through a massive release of nitric oxide (NO) and particulate matter with an aerodynamic diameter of ≤10 mcm is associated with the development of pneumonia in children (Torres-García et al 2019). The European Study of Cohorts for Air Pollution Effects (ES-CAPE) found that pneumonia diagnosed by a doctor in early childhood was largely associated with environmental exposure.…”

RSV testing in the adult; Comments on paper by Drew et al. JCV 117, 2019, pp 27-32

“…The impact of an parainfluenza virus infection, in particular type 3, has a huge impact in for instance lung transplant patients [1][2][3][4]. Also nosocomial infections with this virus (and other respiratory viruses) have been described [5,6]. We should not restrict ourselves for testing for only influenza and RSV because clinicians might have the opinion that we can and should only act on these two viruses.…”