Viral Infection in Patients with Severe Pneumonia Requiring Intensive Care Unit Admission

Choi, Sang‐Ho; Hong, Sang‐Bum; Ko, Gwang-Beom; Lee, Yu‐Mi; Park, Hyun Jung; Park, So-Youn; Moon, Song Mi; Cho, Oh-Hyun; Park, Ki Ho; Chong, Yong Pil; Kim, Sung-Han; Huh, Jin Won; Sung, Heungsup; Do, Kyung-Hyun; Lee, Sang‐Oh; Kim, Mina; Jeong, Jin-Yong; Lim, Chae‐Man; Kim, Yang Soo; Woo, Jun Hee; Koh, Younsuck

doi:10.1164/rccm.201112-2240oc

Cited by 305 publications

(368 citation statements)

References 37 publications

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“…A total of 27 articles encompassing 3215 patients met all the inclusion criteria and were included in the final analysis 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54. Of those 27, only eight studies, with 334 patients, provided the numbers or percentages of each bacterial coinfecting pathogen 28, 32, 33, 34, 38, 43, 46, 47. Thus, these eight studies formed the basis for identifying the most common coinfecting bacterial pathogens (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

“…All 27 included studies were observational, of which 13 (1218 patients) were prospective studies,30, 32, 33, 36, 40, 41, 43, 44, 48, 49, 50, 51, 52 and 14 (1997 patients) were retrospective analyses (Table 1). The majority (21) of studies were cohort studies, and the rest were case–control studies.…”

Section: Resultsmentioning

confidence: 99%

“…Severity of illness varied among studies, but all were focused on hospitalized patients, suggesting a greater than average severity. Eleven of the studies (1007 patients) focused exclusively on patients initially enrolled in an intensive care unit (ICU),32, 34, 35, 38, 39, 41, 42, 44, 46, 47, 51 10 enrolled non‐ICU hospitalized patients (973 patients),30, 33, 36, 37, 40, 43, 45, 49, 53, 54 3 enrolled patients in the emergency department (ED; 135 patients),28, 48, 50 and 2 enrolled patients in a mix of inpatient and outpatient settings (1100 patients) 29, 52. The median sample size was 51 (IQR, 18·5–101), and the mean was 119 (SD: 203), which was driven by three large studies29, 44, 53 that contributed 1958 (61%) of the total number of patients included in this analysis.…”

Section: Resultsmentioning

confidence: 99%

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The frequency of influenza and bacterial coinfection: a systematic review and meta‐analysis

Klein

Monteforte

Gupta

et al. 2016

Influenza Resp Viruses

460

355

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AimCoinfecting bacterial pathogens are a major cause of morbidity and mortality in influenza. However, there remains a paucity of literature on the magnitude of coinfection in influenza patients.MethodA systematic search of MeSH, Cochrane Library, Web of Science, SCOPUS, EMBASE, and PubMed was performed. Studies of humans in which all individuals had laboratory confirmed influenza, and all individuals were tested for an array of common bacterial species, met inclusion criteria.ResultsTwenty‐seven studies including 3215 participants met all inclusion criteria. Common etiologies were defined from a subset of eight articles. There was high heterogeneity in the results (I 2 = 95%), with reported coinfection rates ranging from 2% to 65%. Although only a subset of papers were responsible for observed heterogeneity, subanalyses and meta‐regression analysis found no study characteristic that was significantly associated with coinfection. The most common coinfecting species were Streptococcus pneumoniae and Staphylococcus aureus, which accounted for 35% (95% CI, 14%–56%) and 28% (95% CI, 16%–40%) of infections, respectively; a wide range of other pathogens caused the remaining infections. An assessment of bias suggested that lack of small‐study publications may have biased the results.ConclusionsThe frequency of coinfection in the published studies included in this review suggests that although providers should consider possible bacterial coinfection in all patients hospitalized with influenza, they should not assume all patients are coinfected and be sure to properly treat underlying viral processes. Further, high heterogeneity suggests additional large‐scale studies are needed to better understand the etiology of influenza bacterial coinfection.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The frequency of influenza and bacterial coinfection: a systematic review and meta‐analysis

Klein

Monteforte

Gupta

et al. 2016

Influenza Resp Viruses

460

355

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“…Six studies reported that bronchoalveolar lavage was one of the diagnostic tools used to obtain a microbiological diagnosis [2,7,18,25,28,35]. However, only four of them reported the number of patients who had lower respiratory tract sampling [2,18,25,28].…”

Section: Resultsmentioning

confidence: 99%

“…The advent of PCR has greatly improved the identification of viruses in patients with CAP [1]. Over the last decade, several studies have used PCR to establish the importance of viruses in the aetiology of CAP [1][2][3][4][5][6][7][8][9][10][11][12]. An updated and objective literature review that quantitatively summarises and critically appraises the results of these studies is warranted.…”

Section: Introductionmentioning

confidence: 99%

Viral infection in community-acquired pneumonia: a systematic review and meta-analysis

et al. 2016

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The advent of PCR has improved the identification of viruses in patients with communityacquired pneumonia (CAP). Several studies have used PCR to establish the importance of viruses in the aetiology of CAP.We performed a systematic review and meta-analysis of the studies that reported the proportion of viral infection detected via PCR in patients with CAP. We excluded studies with paediatric populations. The primary outcome was the proportion of patients with viral infection. The secondary outcome was short-term mortality.Our review included 31 studies. Most obtained PCR via nasopharyngeal or oropharyngeal swab. The pooled proportion of patients with viral infection was 24.5% (95% CI 21.5-27.5%). In studies that obtained lower respiratory samples in >50% of patients, the proportion was 44.2% (95% CI 35.1-53.3%). The odds of death were higher in patients with dual bacterial and viral infection (OR 2.1, 95% CI 1.32-3.31).Viral infection is present in a high proportion of patients with CAP. The true proportion of viral infection is probably underestimated because of negative test results from nasopharyngeal or oropharyngeal swab PCR. There is increased mortality in patients with dual bacterial and viral infection. @ERSpublications Viral infection is present in a high proportion of patients with community-acquired pneumonia

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Different pattern of viral infections and clinical outcomes in patient with acute exacerbation of chronic obstructive pulmonary disease and chronic obstructive pulmonary disease with pneumonia

Kim

Choi

Huh

et al. 2016

Journal of Medical Virology

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Respiratory viruses are well-known causes of acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) and also important pathogens for concomitant pneumonia in COPD (CP-COPD). However, the differences in a viral infection pattern and clinical impacts of respiratory viruses between the two groups have not been well investigated. The clinical and microbiological data from COPD patients admitted with AE-COPD (n = 281) or CP-COPD (n = 284) between January 2010 and December 2012 were reviewed. After excluding 88 patients (40 with AE-COPD and 48 with CP-COPD) who did not undergo a multiplex RT-PCR test for respiratory viruses, the demographic characteristics, identified viruses, and clinical outcomes of the AE-COPD and CP-COPD groups were compared. Respiratory viruses were identified in 41.9% of AE-COPD group and 33.5% of the CP-COPD groups. The most common virus was influenza virus in the AE-COPD group (33.7%) versus human coronavirus (24.1%) in the CP-COPD group. Influenza virus was significantly more common in the AE-ACOPD group than in the CP-COPD group (P < 0.01). In-hospital mortality of AE-COPD and CP-COPD were 1.2% and 12.3%, respectively (P < 0.01). Among CP-COPD patients, in-hospital mortality of patients with only viral infection group, only bacterial infection group, and viral-bacterial co-infection were 2.6%, 25.8%, and 17.5%, respectively (P = 0.01). Respiratory viruses were commonly identified in both AE-COPD and CP-COPD, influenza virus and human coronavirus were the most common viruses identified in AE-COPD and CP-COPD patients, respectively. The mortality rates of only viral infection group was significantly lower than only bacterial infection or viral-bacterial co-infection group in CP-COPD patients. J. Med. Virol. 88:2092-2099, 2016. © 2016 Wiley Periodicals, Inc.

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Viral Infection in Patients with Severe Pneumonia Requiring Intensive Care Unit Admission

Abstract: Viruses are frequently found in the airway of patients with pneumonia requiring ICU admission and may cause severe forms of pneumonia. Patients with viral infection and bacterial infection had comparable mortality rates.

Cited by 305 publications

References 37 publications

The frequency of influenza and bacterial coinfection: a systematic review and meta‐analysis

The frequency of influenza and bacterial coinfection: a systematic review and meta‐analysis

Viral infection in community-acquired pneumonia: a systematic review and meta-analysis

Different pattern of viral infections and clinical outcomes in patient with acute exacerbation of chronic obstructive pulmonary disease and chronic obstructive pulmonary disease with pneumonia

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