Respiratory viral infections are underdiagnosed in patients with suspected sepsis

Abstract

The study aim was to investigate the prevalence and clinical relevance of viral findings by multiplex PCR from the nasopharynx of clinically septic patients during a winter season. During 11 weeks of the influenza epidemic period in January–March 2012, consecutive adult patients suspected to be septic (n = 432) were analyzed with cultures from blood and nasopharynx plus multiplex PCR for respiratory viruses on the nasopharyngeal specimen. The results were compared with those from microbiology analyses ordered as part of standard care. During the winter season, viral respiratory pathogens, mainly influenza A virus, human metapneumovirus, coronavirus, and respiratory syncytial virus were clinically underdiagnosed in 70% of patients positive by the multiplex PCR assay. During the first four weeks of the influenza epidemic, few tests for influenza were ordered by clinicians, indicating low awareness that the epidemic had started. Nasopharyngeal findings of Streptococcus pneumoniae and Haemophilus influenzae by culture correlated to pneumonia diagnosis, and in those patients laboratory signs of viral co-infections were common but rarely suspected by clinicians. The role of respiratory viral infections in patients presenting with a clinical picture of sepsis is underestimated. Specific antiviral treatment might be beneficial in some cases and may reduce spread in a hospital setting. Diagnosing viral infections may promote reduction of unnecessary antibiotic use. It can also be a tool for decisions concerning patient logistics, in order to minimize exposure of susceptible patients and personnel.Electronic supplementary materialThe online version of this article (doi:10.1007/s10096-017-2990-z) contains supplementary material, which is available to authorized users.

Pure Viral Sepsis Secondary to Community-Acquired Pneumonia in Adults: Risk and Prognostic Factors

“…We observed that viral sepsis was not a risk factor for in-hospital mortality in patients without septic shock. Our data support those of previous studies in which respiratory viruses were frequently found in critically ill patients with pneumonia but mortality rates did not significantly differ between patients with bacterial infection and those with viral infection [9,10,14]. This highlights the need to identify patients at higher risk of viral sepsis and the importance of a complete microbiological diagnosis in cases of CAP.…”

“…No statistically significant difference was observed between the two groups in terms of in-hospital mortality, ICU mortality, length of ICU stay, 30-day mortality, and 1-year mortality (Table 1). However, patients with sepsis showed longer length of hospital stay, were more frequently admitted to ICU and needed (10) .032 more frequently invasive mechanical ventilation than patients without sepsis.…”

“…Although respiratory viruses are reported to be important causative agents of severe CAP [9], the prevalence of pure viral sepsis is not fully known. A recently published study investigated the role of virus detection by multiplex PCR of nasopharyngeal samples from clinically septic patients during a winter season [10]. The authors reported that respiratory viruses, including influenza A virus, human metapneumovirus, coronavirus, and respiratory syncytial virus were detected in 70% of adult patients with sepsis.…”

Characteristics of community-acquired respiratory viruses infections except seasonal influenza in transplant recipients and non-transplant critically ill patients

“…Of 432 non-transplant patients with suspected sepsis in the previous study, 12 (2.8%) had RSV A/B and 23 (5.3%) had hMPV. 33 Gréve et al reported 7 (0.5%) with hMPV and 21 (1.5%) with RSV among 1407 non-transplant patients admitted to the ICU on MV therapy in a prospective multicenter study in 2018. 11 Recent reports support our findings and indicate that hMPV and RSV should not be regarded as negligible pathogens and could be under-diagnosed in non-transplant critically ill patients, in particular on ventilated and ICU care.…”

A novel real-time PCR assay panel for detection of common respiratory pathogens in a convenient, strip-tube array format

“…The ability to diagnose co-infections is a significant improvement as these can be associated with increased morbidity and mortality (Burk et al, 2016;Marcos et al, 2009;Rea-Neto et al, 2008). Rapid molecular tests have been shown to reduce the length of hospital stay and the cost of testing for those with viral respiratory testing and has facilitated a more targeted approach to patients presenting with respiratory infections with respect to treatment regimens, need for admission and infection control concerns (Barenfanger et al, 2000;Ljungström et al, 2017;Pavia, 2011;Woo et al, 1997).…”