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The Burden Of Viruses in Pneumonia Associated with Acute Respiratory Failure: An Underappreciated Issue.
Chest. 2017 Dec 20;:
Authors: Shorr AF, Fisher K, Micek ST, Kollef MH
Abstract
BACKGROUND: Pneumonia associated with mechanical ventilation (MV) results in substantial mortality and represents a leading reason for antibiotic utilization. The role of viruses in this setting is unclear. Identifying a viral etiology such instances could facilitate antibiotic stewardship.
METHODS: We performed a secondary analysis of a prospective cohort with pneumonia requiring MV. We included both community and hospital-onset cases and classified patients as to the pneumonia's etiology. The prevalence of viral pathogens represented the primary endpoint. We identified variables independently associated with isolation of a viral organism as the sole pathogen.
RESULTS: The cohort included 364 patients, and a virus was the sole pathogen in 79 (21.7%) cases. The most common viruses included: Rhinovirus/Enterovirus (n=20), Influenza A (n=12), and Respiratory syntcytial virus (n=11). The rate of in-hospital death was high (37.2%) and did not differ from that seen in others (36.5%). The duration of MV, hospital length of stay, and 30 day readmission rates also did not differ based on pneumonia etiology. Two variables were independently associated with recovery of a virus: Acute Physiology and Health Evaluation II score of < 26 (adjusted odds ratio [AOR]: 0.51, 95% CI: 0.28-0.93, p=0.027) and stem cell transplantation (SCT) (AOR: 4.39, 95% CI: 2.03-9.50, p=0.001). A sensitivity analysis excluding SCT patients did not substantially alter our observations.
CONCLUSIONS: Viruses represent a major cause of pneumonia in critically ill patients requiring MV. Identifying such subjects presents an opportunity for discontinuing antibiotics. Clinicians should consider systematically evaluating patients with pneumonia requiring MV for viral pathogens.
PMID: 29274318 [PubMed - as supplied by publisher]