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Masri IH, Busack B, Shorr AF. Improving Outcomes in Nosocomial Pneumonia: Recent Evidence and More Challenges. Pathogens 2024; 13:495. [PMID: 38921793 PMCID: PMC11206584 DOI: 10.3390/pathogens13060495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 05/31/2024] [Accepted: 06/08/2024] [Indexed: 06/27/2024] Open
Abstract
Nosocomial pneumonia (NP) represents a leading nosocomial infection and results in substantial morbidity and cost. Over the last several years, the evidence has evolved which directs our approach to NP. Specifically, the definition of NP and classification of its various subtypes has expanded to capture nuances among various phenotypes of this syndrome. For example, segregating those with hospital-acquired pneumonia (HAP) based on whether they subsequently require mechanical ventilation has been shown to be important. Likewise, newer data indicate the true economic cost of NP and underscore the diverse range of pathogens that can cause NP. Moreover, multidrug-resistant (MDR) bacteria have become a major threat in NP. Fortunately, newer simple preventive strategies have been tested and found to be effective at reducing the incidence of NP. Should prevention fail, a range of new antibiotics have been formally studied in NP and found to be effective. Some of these novel agents have relatively broad ranges of activity and are in vitro active against select MDR organisms. Others, however, are narrower in spectrum and directed against specific problem bacteria. In short, the literature in the field of NP has progressed rapidly, and clinicians require a clear appreciation of these changes so as to improve patient outcomes.
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Affiliation(s)
- Ihab H. Masri
- Pulmonary and Critical Care Medicine, Medstar Washington Hospital Center, Washington, DC 20010, USA;
| | - Bethany Busack
- Critical Care Medicine, University of Michigan-West, Wyoming, MI 49519, USA;
| | - Andrew F. Shorr
- Pulmonary and Critical Care Medicine, Medstar Washington Hospital Center, Washington, DC 20010, USA;
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2
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Cilloniz C, Dy-Agra G, Pagcatipunan RS, Torres A. Viral Pneumonia: From Influenza to COVID-19. Semin Respir Crit Care Med 2024; 45:207-224. [PMID: 38228165 DOI: 10.1055/s-0043-1777796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Respiratory viruses are increasingly recognized as a cause of community-acquired pneumonia (CAP). The implementation of new diagnostic technologies has facilitated their identification, especially in vulnerable population such as immunocompromised and elderly patients and those with severe cases of pneumonia. In terms of severity and outcomes, viral pneumonia caused by influenza viruses appears similar to that caused by non-influenza viruses. Although several respiratory viruses may cause CAP, antiviral therapy is available only in cases of CAP caused by influenza virus or respiratory syncytial virus. Currently, evidence-based supportive care is key to managing severe viral pneumonia. We discuss the evidence surrounding epidemiology, diagnosis, management, treatment, and prevention of viral pneumonia.
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Affiliation(s)
- Catia Cilloniz
- Hospital Clinic of Barcelona, IDIBAPS, CIBERESA, Barcelona, Spain
- Faculty of Health Sciences, Continental University, Huancayo, Peru
| | - Guinevere Dy-Agra
- Institute of Pulmonary Medicine, St Luke's Medical Center-Global City, Taguig, Metro Manila, Philippines
| | - Rodolfo S Pagcatipunan
- Institute of Pulmonary Medicine, St Luke's Medical Center-Global City, Taguig, Metro Manila, Philippines
| | - Antoni Torres
- Hospital Clinic of Barcelona, IDIBAPS, CIBERESA, Barcelona, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
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3
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Grangier B, Vacheron CH, De Marignan D, Casalegno JS, Couray-Targe S, Bestion A, Ader F, Richard JC, Frobert E, Argaud L, Rimmele T, Lukaszewicz AC, Aubrun F, Dailler F, Fellahi JL, Bohe J, Piriou V, Allaouchiche B, Friggeri A, Wallet F. Comparison of mortality and outcomes of four respiratory viruses in the intensive care unit: a multicenter retrospective study. Sci Rep 2024; 14:6690. [PMID: 38509095 PMCID: PMC10954612 DOI: 10.1038/s41598-024-55378-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 02/22/2024] [Indexed: 03/22/2024] Open
Abstract
This retrospective study aimed to compare the mortality and burden of respiratory syncytial virus (RSV group), SARS-CoV-2 (COVID-19 group), non-H1N1 (Seasonal influenza group) and H1N1 influenza (H1N1 group) in adult patients admitted to intensive care unit (ICU) with respiratory failure. A total of 807 patients were included. Mortality was compared between the four following groups: RSV, COVID-19, seasonal influenza, and H1N1 groups. Patients in the RSV group had significantly more comorbidities than the other patients. At admission, patients in the COVID-19 group were significantly less severe than the others according to the simplified acute physiology score-2 (SAPS-II) and sepsis-related organ failure assessment (SOFA) scores. Using competing risk regression, COVID-19 (sHR = 1.61; 95% CI 1.10; 2.36) and H1N1 (sHR = 1.87; 95% CI 1.20; 2.93) were associated with a statistically significant higher mortality while seasonal influenza was not (sHR = 0.93; 95% CI 0.65; 1.31), when compared to RSV. Despite occurring in more severe patients, RSV and seasonal influenza group appear to be associated with a more favorable outcome than COVID-19 and H1N1 groups.
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Affiliation(s)
- Baptiste Grangier
- Service de Médecine Intensive Réanimation, Hôpital Lyon SUD, 415 chemin du grand Revoyet, 69495, Pierre-Bénite, France
| | - Charles-Hervé Vacheron
- Service de Médecine Intensive Réanimation, Hôpital Lyon SUD, 415 chemin du grand Revoyet, 69495, Pierre-Bénite, France
- Service de Biostatistique - Bio-informatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Donatien De Marignan
- Service de Médecine Intensive Réanimation, Hôpital Lyon SUD, 415 chemin du grand Revoyet, 69495, Pierre-Bénite, France
| | - Jean-Sebastien Casalegno
- Laboratoire de Virologie, Institut des Agents Infectieux (IAI), Hospices Civils de Lyon, Lyon, France
- Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, Team VirPatH, ENS Lyon, Claude Bernard Lyon 1 University, Lyon, France
| | - Sandrine Couray-Targe
- Pôle de Santé Publique, Département d'Information Médicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Audrey Bestion
- Pôle de Santé Publique, Département d'Information Médicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Florence Ader
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
- Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS UMR5308, ENS Lyon, Claude Bernard Lyon 1 University, Lyon, France
| | - Jean-Christophe Richard
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, Lyon, France
- CNRS, Inserm, CREATIS UMR 5220, U1206, Université de Lyon, Claude Bernard Lyon 1 university, INSA-Lyon, UJM-Saint Etienne, Lyon, France
| | - Emilie Frobert
- Laboratoire de Virologie, Institut des Agents Infectieux (IAI), Hospices Civils de Lyon, Lyon, France
- Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, Team VirPatH, ENS Lyon, Claude Bernard Lyon 1 University, Lyon, France
| | - Laurent Argaud
- Service de Médecine Intensive Réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Thomas Rimmele
- Service d'Anesthésie Réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Anne-Claire Lukaszewicz
- Service d'Anesthésie Réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Aubrun
- Service d'Anesthésie Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Dailler
- Service d'Anesthésie Réanimation, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - Jean-Luc Fellahi
- Service d'Anesthésie Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Julien Bohe
- Service de Médecine Intensive Réanimation, Hôpital Lyon SUD, 415 chemin du grand Revoyet, 69495, Pierre-Bénite, France
| | - Vincent Piriou
- Service de Médecine Intensive Réanimation, Hôpital Lyon SUD, 415 chemin du grand Revoyet, 69495, Pierre-Bénite, France
- RESHAPE Research on Healthcare Performance, U1290, Claude Bernard Lyon 1 university, Lyon, France
| | - Bernard Allaouchiche
- Service de Médecine Intensive Réanimation, Hôpital Lyon SUD, 415 chemin du grand Revoyet, 69495, Pierre-Bénite, France
- Pulmonary and Cardiovascular Aggression in Sepsis (APCSe), Université de Lyon, VetAgro Sup, Campus Vétérinaire de Lyon, UPSP 2016.A101, Marcy l'Étoile, France
| | - Arnaud Friggeri
- Service de Médecine Intensive Réanimation, Hôpital Lyon SUD, 415 chemin du grand Revoyet, 69495, Pierre-Bénite, France
- Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, Team VirPatH, ENS Lyon, Claude Bernard Lyon 1 University, Lyon, France
| | - Florent Wallet
- Service de Médecine Intensive Réanimation, Hôpital Lyon SUD, 415 chemin du grand Revoyet, 69495, Pierre-Bénite, France.
- RESHAPE Research on Healthcare Performance, U1290, Claude Bernard Lyon 1 university, Lyon, France.
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Dumas G, Bertrand M, Lemiale V, Canet E, Barbier F, Kouatchet A, Demoule A, Klouche K, Moreau AS, Argaud L, Wallet F, Raphalen JH, Mokart D, Bruneel F, Pène F, Azoulay E. Prognosis of critically ill immunocompromised patients with virus-detected acute respiratory failure. Ann Intensive Care 2023; 13:101. [PMID: 37833435 PMCID: PMC10575827 DOI: 10.1186/s13613-023-01196-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Acute respiratory failure (ARF) is the leading cause of ICU admission. Viruses are increasingly recognized as a cause of pneumonia in immunocompromised patients, but epidemiologic data are scarce. We used the Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologie's database (2003-2017, 72 intensive care units) to describe the spectrum of critically ill immunocompromised patients with virus-detected ARF and to report their outcomes. Then, patients with virus-detected ARF were matched based on clinical characteristics and severity (1:3 ratio) with patients with ARF from other origins. RESULTS Of the 4038 immunocompromised patients in the whole cohort, 370 (9.2%) had a diagnosis of virus-detected ARF and were included in the study. Influenza was the most common virus (59%), followed by respiratory syncytial virus (14%), with significant seasonal variation. An associated bacterial infection was identified in 79 patients (21%) and an invasive pulmonary aspergillosis in 23 patients (6%). The crude in-hospital mortality rate was 37.8%. Factors associated with mortality were: neutropenia (OR = 1.74, 95% confidence interval, CI [1.05-2.89]), poor performance status (OR = 1.84, CI [1.12-3.03]), and the need for invasive mechanical ventilation on the day of admission (OR = 1.97, CI [1.14-3.40]). The type of virus was not associated with mortality. After matching, patients with virus-detected ARF had lower mortality (OR = 0.77, CI [0.60-0.98]) than patients with ARF from other causes. This result was mostly driven by influenza-like viruses, namely, respiratory syncytial virus, parainfluenza virus, and human metapneumovirus (OR = 0.54, CI [0.33-0.88]). CONCLUSIONS In immunocompromised patients with virus-detected ARF, mortality is high, whatever the species, mainly influenced by clinical severity and poor general status. However, compared to non-viral ARF, in-hospital mortality was lower, especially for patients with detected viruses other than influenza.
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Affiliation(s)
- Guillaume Dumas
- Service de Médecine Intensive-Réanimation, CHU Grenoble-Alpes; Université Grenoble-Alpes, INSERM U1300-HP2, Grenoble, France.
| | - Maxime Bertrand
- Medical Intensive Care Unit, Saint-Louis Teaching Hospital, AP-HP, Paris, France
- ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Université de Paris, Paris, France
| | - Virginie Lemiale
- Medical Intensive Care Unit, Saint-Louis Teaching Hospital, AP-HP, Paris, France
- ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Université de Paris, Paris, France
| | - Emmanuel Canet
- Nantes Université, CHU Nantes, Médecine Intensive Réanimation, 44000, Nantes, France
| | - François Barbier
- Medical Intensive Care Unit, La Source Hospital, CHR Orleans, Orleans, France
| | - Achille Kouatchet
- Medical Intensive Care Unit, Angers Teaching Hospital, Angers, France
| | - Alexandre Demoule
- Service de Médecine Intensive et Réanimation (Département R3S), Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, and AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, 75013, Paris, France
| | - Kada Klouche
- Medical Intensive Care Unit, CHU de Montpellier, Montpellier, France
| | - Anne-Sophie Moreau
- Service de Réanimation Polyvalente, CHRU de Lille - Hôpital Roger Salengro, Lille, France
| | - Laurent Argaud
- Medical Intensive Care Unit, Hospices Civils de Lyon, Hopital Edouard Herriot, Lyon, France
| | - Florent Wallet
- Intensive Care Unit, Lyon Sud Medical Center, Lyon, France
| | | | - Djamel Mokart
- Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Fabrice Bruneel
- Medical Intensive Care Unit, Andre Mignot Hospital, Versailles, France
| | - Frédéric Pène
- Medical Intensive Care Unit, Cochin Hospital, Hôpitaux Universitaires Paris Centre, AP-HP, Paris, France
- Institut Cochin, INSERM Unité 1016/Centre National de La Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR) 8104/Université de Paris, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint-Louis Teaching Hospital, AP-HP, Paris, France
- ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Université de Paris, Paris, France
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Zilberbeg MD, Khan I, Shorr AF. Respiratory Viruses in Nosocomial Pneumonia: An Evolving Paradigm. Viruses 2023; 15:1676. [PMID: 37632017 PMCID: PMC10458412 DOI: 10.3390/v15081676] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/27/2023] Open
Abstract
Nosocomial pneumonia (NP) represents a leading cause of morbidity and mortality in hospitalized patients. Historically, clinicians have considered hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), which comprise NP, to be essentially bacterial processes. As such, patients suspected of having either HAP or VAP are initially treated with broad-spectrum antibiotics, and few clinicians search for a possible culprit virus. Recent reports which build on earlier studies, however, indicate that viruses likely play an important role in NP. Studies employing viral diagnostics as part of the evaluation for NP indicate that common respiratory viruses can spread nosocomially and lead to HAP and VAP. Similarly, studies of the general epidemiology of respiratory viral infections, such as influenza, respiratory syncytial virus, adenovirus, and rhinovirus, confirm that these pathogens are important causes of NP, especially among immunosuppressed and pediatric patients. More importantly, these more contemporary analyses reveal that one cannot, based on clinical characteristics, distinguish a viral from a bacterial cause of NP. Additionally, viral HAP and VAP result in crude mortality rates that rival or exceed those reported in bacterial NP. Rigorous prospective, multicenter trials are needed to confirm the significance of respiratory viruses in NP, as are studies of novel therapeutics for these viral infections.
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Affiliation(s)
| | - Imran Khan
- Pulmonary and Critical Care Medicine, Medstar Washington Hospital Center, Washington, DC 20010, USA;
| | - Andrew F. Shorr
- Pulmonary and Critical Care Medicine, Medstar Washington Hospital Center, Washington, DC 20010, USA;
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Shorr AF, Ilges DT, Micek ST, Kollef MH. The importance of viruses in ventilator-associated pneumonia. Infect Control Hosp Epidemiol 2023; 44:1137-1142. [PMID: 36172891 DOI: 10.1017/ice.2022.223] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Ventilator-associated pneumonia (VAP) remains a challenge. The importance of viruses in VAP is not established. We sought to determine the prevalence of viruses in VAP and the outcomes of viral VAP. DESIGN Retrospective study of VAP over 3 years. The frequency of a viral process represented the primary endpoint. Clinical outcomes served as secondary endpoints. We identified variables independently associated with a virus and conducted sensitivity analyses to assess the interaction between type of infection and patient characteristics. SETTING Tertiary-care referral center. PATIENTS The final cohort consisted of 710 patients and a virus was isolated in 5.1%. INTERVENTIONS None. RESULTS The most common viruses included: rhinovirus, influenza A, and cytomegalovirus. Baseline characteristics were similar between those with and without viral infections. In logistic regression, immunosuppression (adjusted odds ratio [aOR], 2.97; 95% confidence interval [CI], 1.44-6.14) and stem-cell transplantation (SCT, aOR, 3.58; 95% CI, 1.17-10.99) were independently associated with a virus. The presence of either variable performed poorly as a screening test for a virus. In-hospital (22.4% vs 21.6%; P = .869) and 30-day (32.8% vs 27.9%; P = .448) mortality rates were similar between the cohorts, respectively. Sensitivity analyses restricted to patients without a mixed viral and bacterial infection or those who were immunocompetent yielded similar results. CONCLUSION Although infrequent, a range of viruses may cause VAP. Viruses more often complicate SCT and immunosuppression, but one can isolate viruses in immunocompetent subjects. Viral VAP produces severe infection and results in high mortality rates. Clinical features do not differentiate viral from nonviral VAP.
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Affiliation(s)
- Andrew F Shorr
- Pulmonary and Critical Care Medicine, Medstar Washington Hospital Center, Washington, DC
| | - Daniel T Ilges
- Department of Pharmacy, Mayo Clinic, Scottsdale, Arizona
| | - Scott T Micek
- Department of Pharmacy Practice, University of Health Sciences and Pharmacy, St. Louis, Missouri
| | - Marin H Kollef
- Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri
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7
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Rozenbaum MH, Begier E, Kurosky SK, Whelan J, Bem D, Pouwels KB, Postma M, Bont L. Incidence of Respiratory Syncytial Virus Infection in Older Adults: Limitations of Current Data. Infect Dis Ther 2023:10.1007/s40121-023-00802-4. [PMID: 37310617 DOI: 10.1007/s40121-023-00802-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/30/2023] [Indexed: 06/14/2023] Open
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is an important cause of severe respiratory illness in older adults and adults with respiratory or cardiovascular comorbidities. Published estimates of its incidence and prevalence in adult groups vary widely. This article reviews the potential limitations affecting RSV epidemiology studies and suggests points to consider when evaluating or designing them. METHODS Studies reporting the incidence or prevalence of RSV infection in adults in high-income Western countries from 2000 onwards were identified via a rapid literature review. Author-reported limitations were recorded, together with presence of other potential limitations. Data were synthesized narratively, with a focus on factors affecting incidence estimates for symptomatic infection in older adults. RESULTS A total of 71 studies met the inclusion criteria, most in populations with medically attended acute respiratory illness (ARI). Only a minority used case definitions and sampling periods tailored specifically to RSV; many used influenza-based or other criteria that are likely to result in RSV cases being missed. The great majority relied solely on polymerase chain reaction (PCR) testing of upper respiratory tract samples, which is likely to miss RSV cases compared with dual site sampling and/or addition of serology. Other common limitations were studying a single season, which has potential for bias due to seasonal variability; failure to stratify results by age, which underestimates the burden of severe disease in older adults; limited generalizability beyond a limited study setting; and absence of measures of uncertainty in the reporting of results. CONCLUSIONS A significant proportion of studies are likely to underestimate the incidence of RSV infection in older adults, although the effect size is unclear and there is also potential for overestimation. Well-designed studies, together with increased testing for RSV in patients with ARI in clinical practice, are required to accurately capture both the burden of RSV and the potential public health impact of vaccines.
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Affiliation(s)
| | | | | | | | | | | | | | - Louis Bont
- University Medical Center Utrecht, Utrecht, The Netherlands
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8
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Cilloniz C, Luna CM, Hurtado JC, Marcos MÁ, Torres A. Respiratory viruses: their importance and lessons learned from COVID-19. Eur Respir Rev 2022; 31:31/166/220051. [PMID: 36261158 DOI: 10.1183/16000617.0051-2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/30/2022] [Indexed: 01/08/2023] Open
Abstract
Respiratory virus infection can cause severe illnesses capable of inducing acute respiratory failure that can progress rapidly to acute respiratory distress syndrome (ARDS). ARDS is related to poor outcomes, especially in individuals with a higher risk of infection, such as the elderly and those with comorbidities, i.e. obesity, asthma, diabetes mellitus and chronic respiratory or cardiovascular disease. Despite this, effective antiviral treatments available for severe viral lung infections are scarce. The coronavirus disease 2019 (COVID-19) pandemic demonstrated that there is also a need to understand the role of airborne transmission of respiratory viruses. Robust evidence supporting this exists, but better comprehension could help implement adequate measures to mitigate respiratory viral infections. In severe viral lung infections, early diagnosis, risk stratification and prognosis are essential in managing patients. Biomarkers can provide reliable, timely and accessible information possibly helpful for clinicians in managing severe lung viral infections. Although respiratory viruses highly impact global health, more research is needed to improve care and prognosis of severe lung viral infections. In this review, we discuss the epidemiology, diagnosis, clinical characteristics, management and prognosis of patients with severe infections due to respiratory viruses.
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Affiliation(s)
- Catia Cilloniz
- Pneumology Dept, Respiratory Institute, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain .,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain.,Faculty of Health Sciences, Continental University, Huancayo, Peru
| | - Carlos M Luna
- Pneumology Division, Hospital of Clínicas, Faculty of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Juan Carlos Hurtado
- Dept of Microbiology, Hospital Clinic, Universitat de Barcelona, ISGlobal, Barcelona, Spain
| | - María Ángeles Marcos
- Dept of Microbiology, Hospital Clinic, Universitat de Barcelona, ISGlobal, Barcelona, Spain
| | - Antoni Torres
- Pneumology Dept, Respiratory Institute, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
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9
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Busack B, Shorr AF. Going Viral-RSV as the Neglected Adult Respiratory Virus. Pathogens 2022; 11:1324. [PMID: 36422576 PMCID: PMC9692430 DOI: 10.3390/pathogens11111324] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 09/17/2023] Open
Abstract
Human respiratory syncytial virus (RSV) is increasingly recognized as a significant viral pathogen in adults with acute respiratory illness, particularly in the elderly, the immunocompromised, and those with underlying cardiopulmonary disease. Although long acknowledged as one of the most common causes of upper respiratory tract infections (URI) in children since its discovery in 1956, the true burden of disease in adults is likely significantly under-recognized. The emerging evidence of RSV as a driver of morbidity and mortality in elderly and immunocompromised patients has sparked advances in vaccine development and renewed interest in quantifying the true burden of disease. This review attempts to summarize the findings of the most recent evidence investigating the burden of RSV related disease in adults and to highlight where future research is needed.
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Affiliation(s)
- Bethany Busack
- Department of Medicine, Medstar Washington Hospital Center, Washington, DC 20010, USA
- Pulmonary and Critical Care Medicine Section, Medstar Washington Hospital Center, Washington, DC 20010, USA
| | - Andrew F. Shorr
- Department of Medicine, Medstar Washington Hospital Center, Washington, DC 20010, USA
- Pulmonary and Critical Care Medicine Section, Medstar Washington Hospital Center, Washington, DC 20010, USA
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10
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Oza PP, Kashfi K. Utility of NO and H 2S donating platforms in managing COVID-19: Rationale and promise. Nitric Oxide 2022; 128:72-102. [PMID: 36029975 PMCID: PMC9398942 DOI: 10.1016/j.niox.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/01/2022] [Accepted: 08/10/2022] [Indexed: 01/08/2023]
Abstract
Viral infections are a continuing global burden on the human population, underscored by the ramifications of the COVID-19 pandemic. Current treatment options and supportive therapies for many viral infections are relatively limited, indicating a need for alternative therapeutic approaches. Virus-induced damage occurs through direct infection of host cells and inflammation-related changes. Severe cases of certain viral infections, including COVID-19, can lead to a hyperinflammatory response termed cytokine storm, resulting in extensive endothelial damage, thrombosis, respiratory failure, and death. Therapies targeting these complications are crucial in addition to antiviral therapies. Nitric oxide and hydrogen sulfide are two endogenous gasotransmitters that have emerged as key signaling molecules with a broad range of antiviral actions in addition to having anti-inflammatory properties and protective functions in the vasculature and respiratory system. The enhancement of endogenous nitric oxide and hydrogen sulfide levels thus holds promise for managing both early-stage and later-stage viral infections, including SARS-CoV-2. Using SARS-CoV-2 as a model for similar viral infections, here we explore the current evidence regarding nitric oxide and hydrogen sulfide's use to limit viral infection, resolve inflammation, and reduce vascular and pulmonary damage.
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Affiliation(s)
- Palak P Oza
- Department of Molecular, Cellular and Biomedical Sciences, Sophie Davis School of Biomedical Education, City University of New York School of Medicine, New York, NY, 10031, USA
| | - Khosrow Kashfi
- Department of Molecular, Cellular and Biomedical Sciences, Sophie Davis School of Biomedical Education, City University of New York School of Medicine, New York, NY, 10031, USA; Graduate Program in Biology, City University of New York Graduate Center, New York, 10091, USA.
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Bergin SP, Calvert SB, Farley J, Sun JL, Chiswell K, Dieperink W, Kluytmans J, Lopez-Delgado JC, Leon-Lopez R, Zervos MJ, Kollef MH, Sims M, Kabchi BA, Rubin D, Santiago J, Natarajan M, Tenaerts P, Fowler VG, Holland TL, Bonten MJ, Hullegie SJ. PROPHETIC EU: Prospective Identification of Pneumonia in Hospitalized Patients in the Intensive Care Unit in European and United States Cohorts. Open Forum Infect Dis 2022; 9:ofac231. [PMID: 35836748 PMCID: PMC9274438 DOI: 10.1093/ofid/ofac231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The prospective identification of patients at high risk for hospital-acquired/ventilator-associated bacterial pneumonia may improve clinical trial feasibility and foster antibacterial development. In a prior study conducted in the United States, clinical criteria were used to prospectively identify these patients; however, these criteria have not been applied in a European population.
Methods
Adults considered high risk for pneumonia (treatment with ventilation or high levels of supplemental oxygen) in the intensive care units of seven European hospitals were prospectively enrolled from June 12-December 27, 2017. We estimated the proportion of high-risk patients developing pneumonia according to United States Food and Drug Administration guidance and a subset potentially eligible for antibacterial trial enrollment. We compared patient characteristics, treatment exposures, and pneumonia incidence in the European and previously described United States cohorts.
Results
Of 888 high-risk patients, 211/888 (24%) were treated for possible pneumonia and 150/888 (17%) met the Food and Drug Administration definition for hospital-acquired/ventilator-associated bacterial pneumonia. A higher proportion of European patients treated for possible pneumonia met the pneumonia definition (150/211 [71%] versus 537/1464 [37%], p<0.001). Among patients developing pneumonia, a higher proportion of European patients met antibacterial trial eligibility criteria (124/150 [83%] versus 371/537 [69%], p<0.001).
Conclusions
Clinical criteria prospectively identified high-risk patients with high rates of pneumonia in the European cohort. Despite higher rates of established risk factors and incident pneumonia, European patients were significantly less likely to receive antibiotics for possible pneumonia than United States patients. Different treatment practices may contribute to lower rates of antibacterial trial enrollment in the United States.
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Affiliation(s)
| | | | - John Farley
- U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, MD, USA
| | - Jie-Lena Sun
- Duke Clinical Research Institute, Durham, NC, USA
| | | | | | | | | | - Rafael Leon-Lopez
- Reina Sofía University Hospital/University of Córdoba, Córdoba, Spain
| | | | - Marin H. Kollef
- Washington University School of Medicine, St Louis, Missouri, USA
| | | | | | - Daniel Rubin
- U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, MD, USA
| | - Jonas Santiago
- U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, MD, USA
| | - Mukil Natarajan
- U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, MD, USA
| | | | - Vance G. Fowler
- Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Thomas L. Holland
- Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Marc J. Bonten
- University Medical Center Utrecht, Utrecht, the Netherlands
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12
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Heo M, Jeong JH, Ju S, Lee SJ, Jeong YY, Lee JD, Yoo JW. Comparison of Clinical Features and Outcomes between SARS-CoV-2 and Non-SARS-CoV-2 Respiratory Viruses Associated Acute Respiratory Distress Syndrome: Retrospective Analysis. J Clin Med 2022; 11:jcm11082246. [PMID: 35456338 PMCID: PMC9027313 DOI: 10.3390/jcm11082246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/15/2022] [Accepted: 04/15/2022] [Indexed: 12/15/2022] Open
Abstract
Although a few studies comparing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and non-SARS-CoV-2 respiratory viruses have been reported, clinical features and outcomes comparing SARS-CoV-2 and non-SARS-CoV-2 respiratory viruses associated acute respiratory distress syndrome (ARDS) are still lacking. We retrospectively identified patients with SARS-CoV-2 (November 2020 to January 2022) and non-SARS-CoV-2 respiratory viruses associated ARDS (February 2015 to November 2020) at a single tertiary hospital. Their clinical data were obtained by medical record review. All viral infections were confirmed by RT-PCR. Thirty-one SARS-CoV-2 and seventy-one patients with non-SARS-CoV-2 respiratory viruses associated ARDS patients were identified. Influenza (62%) was the most common in non-SARS-CoV-2 respiratory viruses associated ARDS patients. Patients with SARS-CoV-2 were more likely to be female and had higher body mass index, lower clinical frailty, APACHE II, and SOFA score than those with non-SARS-CoV-2 respiratory viruses. All patients with SARS-CoV-2 were treated with corticosteroids and used more high-flow nasal oxygen than those with non-SARS-CoV-2 respiratory viruses. The concomitant respiratory bacterial infection was significantly higher in non-SARS-CoV-2 respiratory viruses than SARS-CoV-2. Although there were no significant differences in the 28-, 60-day, and in-hospital mortality rates between SARS-CoV-2 and non-SARS-CoV-2 respiratory viruses associated ARDS, the duration of mechanical ventilation and length of hospital stay were significantly longer in patients with SARS-CoV-2 than those with non-SARS-CoV-2 respiratory viruses. Although the severity of illness and the concomitant bacterial infection rate were lower in patients with SARS-CoV-2 associated ARDS, mortality rates did not differ from non-SARS-CoV-2 respiratory viruses associated ARDS.
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Affiliation(s)
- Manbong Heo
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju 52727, Korea; (M.H.); (J.H.J.); (S.J.); (S.J.L.); (Y.Y.J.); (J.D.L.)
| | - Jong Hwan Jeong
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju 52727, Korea; (M.H.); (J.H.J.); (S.J.); (S.J.L.); (Y.Y.J.); (J.D.L.)
| | - Sunmi Ju
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju 52727, Korea; (M.H.); (J.H.J.); (S.J.); (S.J.L.); (Y.Y.J.); (J.D.L.)
- School of Medicine, Gyeongsang National University, Jinju 52828, Korea
| | - Seung Jun Lee
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju 52727, Korea; (M.H.); (J.H.J.); (S.J.); (S.J.L.); (Y.Y.J.); (J.D.L.)
- School of Medicine, Gyeongsang National University, Jinju 52828, Korea
| | - Yi Yeong Jeong
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju 52727, Korea; (M.H.); (J.H.J.); (S.J.); (S.J.L.); (Y.Y.J.); (J.D.L.)
- School of Medicine, Gyeongsang National University, Jinju 52828, Korea
| | - Jong Deog Lee
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju 52727, Korea; (M.H.); (J.H.J.); (S.J.); (S.J.L.); (Y.Y.J.); (J.D.L.)
- School of Medicine, Gyeongsang National University, Jinju 52828, Korea
| | - Jung-Wan Yoo
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju 52727, Korea; (M.H.); (J.H.J.); (S.J.); (S.J.L.); (Y.Y.J.); (J.D.L.)
- Correspondence: ; Tel.: +82-55-750-9783; Fax: +82-55-758-9122
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13
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Cillóniz C, Pericàs JM, Rojas JR, Torres A. Severe Infections Due to Respiratory Viruses. Semin Respir Crit Care Med 2022; 43:60-74. [PMID: 35172359 DOI: 10.1055/s-0041-1740982] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Severe viral infections may result in severe illnesses capable of causing acute respiratory failure that could progress rapidly to acute respiratory distress syndrome (ARDS), related to worse outcomes, especially in individuals with a higher risk of infection, including the elderly and those with comorbidities such as asthma, diabetes mellitus and chronic respiratory or cardiovascular disease. In addition, in cases of severe viral pneumonia, co-infection with bacteria such as Streptococcus pneumoniae and Staphylococcus aureus is related to worse outcomes. Respiratory viruses like influenza, rhinovirus, parainfluenza, adenovirus, metapneumovirus, respiratory syncytial virus, and coronavirus have increasingly been detected. This trend has become more prevalent, especially in critically ill patients, due to the availability and implementation of molecular assays in clinical practice. Respiratory viruses have been diagnosed as a frequent cause of severe pneumonia, including cases of community-acquired pneumonia, hospital-acquired pneumonia, and ventilator-associated pneumonia. In this review, we will discuss the epidemiology, diagnosis, clinical characteristics, management, and prognosis of patients with severe infections due to respiratory viruses, with a focus on influenza viruses, non-influenza viruses, and coronaviruses.
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Affiliation(s)
- Catia Cillóniz
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| | - Juan M Pericàs
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain.,Internal Medicine Department, Vall d'Hebron Institute for Research, Barcelona, Spain
| | - Jorge R Rojas
- Department of Pneumology, Hospital Regional Docente Clínico Quirúrgico Daniel Alcides Carrión, Huancayo, Perú
| | - Antoni Torres
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
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14
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Renaud C, Kollef MH. Classical and Molecular Techniques to Diagnose HAP/VAP. Semin Respir Crit Care Med 2022; 43:219-228. [PMID: 35042263 DOI: 10.1055/s-0041-1739359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Nosocomial pneumonia, including hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), are the most common nosocomial infections occurring in critically ill patients requiring intensive care. However, challenges exist in making a timely and accurate diagnosis of HAP and VAP. Under diagnosis of HAP and VAP can result in greater mortality risk, especially if accompanied by delays in the administration of appropriate antimicrobial treatment. Over diagnosis of HAP and VAP results in the unnecessary administration of broad spectrum antibiotics that can lead to further escalation of antibiotic resistance. Optimal diagnosis and management of HAP and VAP require a systematic approach that combines clinical and radiographic assessments along with proper microbiologic techniques. The use of more invasive sampling methods (bronchoalveolar lavage and protected specimen brush) may enhance specimen collection resulting in more specific diagnoses to limit unnecessary antibiotic exposure. Molecular techniques, currently in use and investigational technique, may improve the diagnosis of HAP and VAP by allowing more rapid identification of offending pathogens, if present, thus increasing both appropriate antibiotic treatment and avoiding unnecessary drug exposure.
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Affiliation(s)
- Cherie Renaud
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Marin H Kollef
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri
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15
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Klompas M. New Insights into the Prevention of Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia Caused by Viruses. Semin Respir Crit Care Med 2022; 43:295-303. [PMID: 35042261 DOI: 10.1055/s-0041-1740582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A fifth or more of hospital-acquired pneumonias may be attributable to respiratory viruses. The SARS-CoV-2 pandemic has clearly demonstrated the potential morbidity and mortality of respiratory viruses and the constant threat of nosocomial transmission and hospital-based clusters. Data from before the pandemic suggest the same can be true of influenza, respiratory syncytial virus, and other respiratory viruses. The pandemic has also helped clarify the primary mechanisms and risk factors for viral transmission. Respiratory viruses are primarily transmitted by respiratory aerosols that are routinely emitted when people exhale, talk, and cough. Labored breathing and coughing increase aerosol generation to a much greater extent than intubation, extubation, positive pressure ventilation, and other so-called aerosol-generating procedures. Transmission risk is proportional to the amount of viral exposure. Most transmissions take place over short distances because respiratory emissions are densest immediately adjacent to the source but then rapidly dilute and diffuse with distance leading to less viral exposure. The primary risk factors for transmission then are high viral loads, proximity, sustained exposure, and poor ventilation as these all increase net viral exposure. Poor ventilation increases the risk of long-distance transmission by allowing aerosol-borne viruses to accumulate over time leading to higher levels of exposure throughout an enclosed space. Surgical and procedural masks reduce viral exposure but do not eradicate it and thus lower but do not eliminate transmission risk. Most hospital-based clusters have been attributed to delayed diagnoses, transmission between roommates, and staff-to-patient infections. Strategies to prevent nosocomial respiratory viral infections include testing all patients upon admission, preventing healthcare providers from working while sick, assuring adequate ventilation, universal masking, and vaccinating both patients and healthcare workers.
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Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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16
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Lynch JP, Kajon AE. Adenovirus: Epidemiology, Global Spread of Novel Types, and Approach to Treatment. Semin Respir Crit Care Med 2021; 42:800-821. [PMID: 34918322 DOI: 10.1055/s-0041-1733802] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Adenoviruses (AdVs) are DNA viruses that typically cause mild infections involving the upper or lower respiratory tract, gastrointestinal tract, or conjunctiva. Rare manifestations of AdV infections include hemorrhagic cystitis, hepatitis, hemorrhagic colitis, pancreatitis, nephritis, or meningoencephalitis. AdV infections are more common in young children, due to lack of humoral immunity. Epidemics of AdV infection may occur in healthy children or adults in closed or crowded settings (particularly military recruits). The vast majority of cases are self-limited. However, the clinical spectrum is broad and fatalities may occur. Dissemination is more likely in patients with impaired immunity (e.g., organ transplant recipients, human immunodeficiency virus infection). Fatality rates for untreated severe AdV pneumonia or disseminated disease may exceed 50%. More than 100 genotypes and 52 serotypes of AdV have been identified and classified into seven species designated HAdV-A through -G. Different types display different tissue tropisms that correlate with clinical manifestations of infection. The predominant types circulating at a given time differ among countries or regions, and change over time. Transmission of novel strains between countries or across continents and replacement of dominant viruses by new strains may occur. Treatment of AdV infections is controversial, as prospective, randomized therapeutic trials have not been done. Cidofovir has been the drug of choice for severe AdV infections, but not all patients require treatment. Live oral vaccines are highly efficacious in reducing the risk of respiratory AdV infection and are in routine use in the military in the United States but currently are not available to civilians.
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Affiliation(s)
- Joseph P Lynch
- Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, Department of Internal Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Adriana E Kajon
- Infectious Disease Program, Lovelace Biomedical Research Institute, Albuquerque, New Mexico
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17
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Respiratory viral infections in pragmatically selected adults in intensive care units. Sci Rep 2021; 11:20058. [PMID: 34625621 PMCID: PMC8501073 DOI: 10.1038/s41598-021-99608-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/23/2021] [Indexed: 12/21/2022] Open
Abstract
Respiratory viruses can be detected in 18.3 to 48.9% of critically ill adults with severe respiratory tract infections (RTIs). The present study aims to assess the clinical significance of respiratory viruses in pragmatically selected adults in medical intensive care unit patients and to identify factors associated with viral respiratory viral tract infections (VRTIs). We conducted a prospective study on critically ill adults with suspected RTIs without recognized respiratory pathogens. Viral cultures with monoclonal antibody identification, in-house real-time polymerase chain reaction (PCR) for influenza virus, and FilmArray respiratory panel were used to detect viral pathogens. Multivariable logistic regression was applied to identify factors associated with VRTIs. Sixty-four (40.5%) of the included 158 critically ill adults had respiratory viruses detected in their respiratory specimens. The commonly detected viruses included influenza virus (20), followed by human rhinovirus/enterovirus (11), respiratory syncitial virus (9), human metapneumovirus (9), human parainfluenza viruses (8), human adenovirus (7), and human coronaviruses (2). The FilmArray respiratory panel detected respiratory viruses in 54 (34.6%) patients, but showed negative results for seven of 13 patients with influenza A/H3 infection. In the multivariable logistic regression model, patient characters associated with VRTIs included those aged < 65 years, household contact with individuals with upper RTI, the presence of fever, cough with sputum production, and sore throat. Respiratory viruses were not uncommonly detected in the pragmatically selected adults with critical illness. The application of multiplex PCR testing for respiratory viruses in selected patient population is a practical strategy, and the viral detection rate could be further improved by the patient characters recognized in this study.
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18
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Evans SE, Jennerich AL, Azar MM, Cao B, Crothers K, Dickson RP, Herold S, Jain S, Madhavan A, Metersky ML, Myers LC, Oren E, Restrepo MI, Semret M, Sheshadri A, Wunderink RG, Dela Cruz CS. Nucleic Acid-based Testing for Noninfluenza Viral Pathogens in Adults with Suspected Community-acquired Pneumonia. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2021; 203:1070-1087. [PMID: 33929301 PMCID: PMC8314899 DOI: 10.1164/rccm.202102-0498st] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background: This document provides evidence-based clinical practice guidelines on the diagnostic utility of nucleic acid–based testing of respiratory samples for viral pathogens other than influenza in adults with suspected community-acquired pneumonia (CAP). Methods: A multidisciplinary panel developed a Population–Intervention–Comparison–Outcome question, conducted a pragmatic systematic review, and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations. Results: The panel evaluated the literature to develop recommendations regarding whether routine diagnostics should include nucleic acid–based testing of respiratory samples for viral pathogens other than influenza in suspected CAP. The evidence addressing this topic was generally adjudicated to be of very low quality because of risk of bias and imprecision. Furthermore, there was little direct evidence supporting a role for routine nucleic acid–based testing of respiratory samples in improving critical outcomes such as overall survival or antibiotic use patterns. However, on the basis of direct and indirect evidence, recommendations were made for both outpatient and hospitalized patients with suspected CAP. Testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was not addressed in the literature at the time of the evidence review. Conclusions: The panel formulated and provided their rationale for recommendations on nucleic acid–based diagnostics for viral pathogens other than influenza for patients with suspected CAP.
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19
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Abstract
PURPOSE OF REVIEW This review aims to evaluate the evidence and recommendations for the prescription of corticosteroids as adjunctive therapy in patients with severe community-acquired pneumonia. RECENT FINDINGS Corticosteroids have been prescribed with the objective to attenuate the marked and persistent activation of the immune system. However, some causes of community-acquired pneumonia, namely viral, are associated with unexpected low levels of cytokines and depressed cellular immunity. As a result, several recent randomized controlled trials and large prospective observational studies repeatedly showed that corticosteroids had no impact on survival, and in some types of pneumonia like influenza, its use was associated with potential harmful effects like invasive aspergillosis. Apart from this, adverse effects, namely hyperglycemia, superinfections and increased length-of-stay, were frequent findings in the corticosteroid-treated patients. SUMMARY According to the current evidence, corticosteroids are recommended in Pneumocystis jiroveci pneumonia in HIV-infected patients and recommendations are against its use in influenza. In all other forms of severe community-acquired pneumonia, with the exclusion of SARS-CoV-2 pneumonia, the strength of the evidence does not support the safe and widespread use of corticosteroids as adjunctive therapy. Further studies are needed to identify subgroups of severe community-acquired pneumonia that can benefit or not from corticosteroids.
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20
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21
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Respiratory viral testing and antibacterial treatment in patients hospitalized with community-acquired pneumonia. Infect Control Hosp Epidemiol 2020; 42:817-825. [PMID: 33256870 DOI: 10.1017/ice.2020.1312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Viruses are more common than bacteria in patients hospitalized with community-acquired pneumonia. Little is known, however, about the frequency of respiratory viral testing and its associations with antimicrobial utilization. DESIGN Retrospective cohort study. SETTING The study included 179 US hospitals. PATIENTS Adults admitted with pneumonia between July 2010 and June 2015. METHODS We assessed the frequency of respiratory virus testing and compared antimicrobial utilization, mortality, length of stay, and costs between tested versus untested patients, and between virus-positive versus virus-negative patients. RESULTS Among 166,273 patients with pneumonia on admission, 40,787 patients (24.5%) were tested for respiratory viruses, 94.8% were tested for influenza, and 20.7% were tested for other viruses. Viral assays were positive in 5,133 of 40,787 tested patients (12.6%), typically for influenza and rhinovirus. Tested patients were younger and had fewer comorbidities than untested patients, but patients with positive viral assays were older and had more comorbidities than those with negative assays. Blood cultures were positive for bacterial pathogens in 2.7% of patients with positive viral assays versus 5.3% of patients with negative viral tests (P < .001). Antibacterial courses were shorter for virus-positive versus -negative patients overall (mean 5.5 vs 6.4 days; P < .001) but varied by bacterial testing: 8.1 versus 8.0 days (P = .60) if bacterial tests were positive; 5.3 versus 6.1 days (P < .001) if bacterial tests were negative; and 3.3 versus 5.2 days (P < .001) if bacterial tests were not obtained (interaction P < .001). CONCLUSIONS A minority of patients hospitalized with pneumonia were tested for respiratory viruses; only a fraction of potential viral pathogens were assayed; and patients with positive viral tests often received long antibacterial courses.
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22
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Crimi C, Noto A, Cortegiani A, Impellizzeri P, Elliott M, Ambrosino N, Gregoretti C. Noninvasive respiratory support in acute hypoxemic respiratory failure associated with COVID-19 and other viral infections. Minerva Anestesiol 2020; 86:1190-1204. [DOI: 10.23736/s0375-9393.20.14785-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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23
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Gautam S, Cohen AJ, Stahl Y, Valda Toro P, Young GM, Datta R, Yan X, Ristic NT, Bermejo SD, Sharma L, Restrepo MI, Dela Cruz CS. Severe respiratory viral infection induces procalcitonin in the absence of bacterial pneumonia. Thorax 2020; 75:974-981. [PMID: 32826284 DOI: 10.1136/thoraxjnl-2020-214896] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Procalcitonin expression is thought to be stimulated by bacteria and suppressed by viruses via interferon signalling. Consequently, during respiratory viral illness, clinicians often interpret elevated procalcitonin as evidence of bacterial coinfection, prompting antibiotic administration. We sought to evaluate the validity of this practice and the underlying assumption that viral infection inhibits procalcitonin synthesis. METHODS We conducted a retrospective cohort study of patients hospitalised with pure viral infection (n=2075) versus bacterial coinfection (n=179). The ability of procalcitonin to distinguish these groups was assessed. In addition, procalcitonin and interferon gene expression were evaluated in murine and cellular models of influenza infection. RESULTS Patients with bacterial coinfection had higher procalcitonin than those with pure viral infection, but also more severe disease and higher mortality (p<0.001). After matching for severity, the specificity of procalcitonin for bacterial coinfection dropped substantially, from 72% to 61%. In fact, receiver operating characteristic curve analysis showed that procalcitonin was a better indicator of multiple indices of severity (eg, organ failures and mortality) than of coinfection. Accordingly, patients with severe viral infection had elevated procalcitonin. In murine and cellular models of influenza infection, procalcitonin was also elevated despite bacteriologic sterility and correlated with markers of severity. Interferon signalling did not abrogate procalcitonin synthesis. DISCUSSION These studies reveal that procalcitonin rises during pure viral infection in proportion to disease severity and is not suppressed by interferon signalling, in contrast to prior models of procalcitonin regulation. Applied clinically, our data suggest that procalcitonin represents a better indicator of disease severity than bacterial coinfection during viral respiratory infection.
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Affiliation(s)
- Samir Gautam
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Avi J Cohen
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Yannick Stahl
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Patricia Valda Toro
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Grant M Young
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rupak Datta
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Xiting Yan
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Nicholas T Ristic
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Santos D Bermejo
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lokesh Sharma
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Marcos I Restrepo
- Division of Pulmonary Diseases and Critical Care Medicine, University of Texas Health, San Antonio, Texas, USA.,Section of Pulmonary & Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Charles S Dela Cruz
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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PROPHETIC: Prospective Identification of Pneumonia in Hospitalized Patients in the ICU. Chest 2020; 158:2370-2380. [PMID: 32615191 DOI: 10.1016/j.chest.2020.06.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 05/07/2020] [Accepted: 06/07/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Pneumonia is the leading infection-related cause of death. The use of simple clinical criteria and contemporary epidemiology to identify patients at high risk of nosocomial pneumonia should enhance prevention efforts and facilitate development of new treatments in clinical trials. RESEARCH QUESTION What are the clinical criteria and contemporary epidemiology trends that are helpful in the identification of patients at high risk of nosocomial pneumonia? STUDY DESIGN AND METHODS Within the ICUs of 28 US hospitals, we conducted a prospective cohort study among adults who had been hospitalized >48 hours and were considered high risk for pneumonia (defined as treatment with invasive or noninvasive ventilatory support or high levels of supplemental oxygen). We estimated the proportion of high-risk patients who experienced the development of nosocomial pneumonia. Using multivariable logistic regression, we identified patient characteristics and treatment exposures that are associated with increased risk of pneumonia development during the ICU admission. RESULTS Between February 6, 2016, and October 7, 2016, 4,613 high-risk patients were enrolled. Among 1,464 high-risk patients (32%) who were treated for possible nosocomial pneumonia, 537 (37%) met the study pneumonia definition. Among high-risk patients, a multivariable logistic model was developed to identify key patient characteristics and treatment exposures that are associated with increased risk of nosocomial pneumonia development (c-statistic, 0.709; 95% CI, 0.686-0.731). Key factors associated with increased odds of nosocomial pneumonia included an admission diagnosis of trauma or cerebrovascular accident, receipt of enteral nutrition, documented aspiration risk, and receipt of systemic antibacterials within the preceding 90 days. INTERPRETATION Treatment for nosocomial pneumonia is common among patients in the ICU who are receiving high levels of respiratory support, yet more than one-half of patients who are treated do not fulfill standard diagnostic criteria for pneumonia. Application of simple clinical criteria may improve the feasibility of clinical trials of pneumonia prevention and treatment by facilitating prospective identification of patients at highest risk.
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Abstract
PURPOSE OF REVIEW To describe the evolving microbiology of various forms of pneumonia and the importance of viruses as etiologic causes of pneumonia. RECENT FINDINGS Multiple studies utilizing novel diagnostic modalities demonstrate that the prevalence of viruses as causes for pneumonia varies from approximately 10-30% depending on the specific pneumonia type evaluated. Viral pneumonias appear similar in presentation and severity of illness to bacterial causes of pulmonary infection. Clinical criteria do not reliably allow the differentiation of viral from bacterial causes in pneumonia. SUMMARY Viruses represent a pool of important culprit organisms in pneumonia and identification of a viral pathogen may facilitate attempts at antibiotic stewardship.
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The Clinical Presentation and Immunology of Viral Pneumonia and Implications for Management of Coronavirus Disease 2019. Crit Care Explor 2020; 2:e0109. [PMID: 32426751 PMCID: PMC7188425 DOI: 10.1097/cce.0000000000000109] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This review will briefly examine the clinical presentation and important immunology of viral pneumonia with a focus on severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019).
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Abstract
Human rhinoviruses (RV) belong to the Picornaviridae and are divided into three species: rhinovirus A, B and C. As causative viruses of upper airway infections (common cold), they possess enormous epidemiological and clinical importance. Furthermore, rhinoviruses are significant pathogens of acute exacerbations of chronic airway diseases such as asthma and chronic obstructive pulmonary disease. Their role as a cofactor in the development of pneumonia and their relevance in critically ill patients is still unclear and the focus of current research. Due to the unspecific clinical symptoms, diagnosis is difficult. Laboratory detection is sophisticated and a distinction between clinically relevant infection and contamination not always possible. Specific therapeutic antiviral strategies against rhinovirus infection do not exist as yet and, due to the large variety of subtypes, the development of vaccines remains a considerable challenge.
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Affiliation(s)
- A Grünewaldt
- Pneumologie/Allergologie, Medizinische Klinik 1, Universitätsklinikum Frankfurt, Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - C Hügel
- Pneumologie/Allergologie, Medizinische Klinik 1, Universitätsklinikum Frankfurt, Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - G G U Rohde
- Pneumologie/Allergologie, Medizinische Klinik 1, Universitätsklinikum Frankfurt, Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
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Ison MG, Hirsch HH. Community-Acquired Respiratory Viruses in Transplant Patients: Diversity, Impact, Unmet Clinical Needs. Clin Microbiol Rev 2019; 32:e00042-19. [PMID: 31511250 PMCID: PMC7399564 DOI: 10.1128/cmr.00042-19] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Patients undergoing solid-organ transplantation (SOT) or allogeneic hematopoietic cell transplantation (HCT) are at increased risk for infectious complications. Community-acquired respiratory viruses (CARVs) pose a particular challenge due to the frequent exposure pre-, peri-, and posttransplantation. Although influenza A and B viruses have a top priority regarding prevention and treatment, recent molecular diagnostic tests detecting an array of other CARVs in real time have dramatically expanded our knowledge about the epidemiology, diversity, and impact of CARV infections in the general population and in allogeneic HCT and SOT patients. These data have demonstrated that non-influenza CARVs independently contribute to morbidity and mortality of transplant patients. However, effective vaccination and antiviral treatment is only emerging for non-influenza CARVs, placing emphasis on infection control and supportive measures. Here, we review the current knowledge about CARVs in SOT and allogeneic HCT patients to better define the magnitude of this unmet clinical need and to discuss some of the lessons learned from human influenza virus, respiratory syncytial virus, parainfluenzavirus, rhinovirus, coronavirus, adenovirus, and bocavirus regarding diagnosis, prevention, and treatment.
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Affiliation(s)
- Michael G Ison
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Hans H Hirsch
- Transplantation & Clinical Virology, Department of Biomedicine, University of Basel, Basel, Switzerland
- Clinical Virology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland
- Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
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29
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Shorr AF, Kollef MH. Response. Chest 2019; 154:224. [PMID: 30044736 DOI: 10.1016/j.chest.2018.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 02/26/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Andrew F Shorr
- Pulmonary and Critical Care Medicine, Medstar Washington Hospital Center, Washington, DC.
| | - Marin H Kollef
- Division of Pulmonary and Critical Care Medicine, Barnes Jewish Christian Hospital, St. Louis, MO
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Póvoa P, Coelho L. Clinical Significance of Viral Detection in Critically Ill Patients. More Questions Than Answers. Am J Respir Crit Care Med 2019; 199:411-413. [PMID: 30312549 DOI: 10.1164/rccm.201809-1778ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Pedro Póvoa
- 1 Polyvalent Intensive Care Unit Hospital de São Francisco Xavier Lisbon, Portugal.,2 NOVA Medical School New University of Lisbon Lisbon, Portugal and.,3 Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology Odense University Hospital Odense, Denmark
| | - Luís Coelho
- 1 Polyvalent Intensive Care Unit Hospital de São Francisco Xavier Lisbon, Portugal.,2 NOVA Medical School New University of Lisbon Lisbon, Portugal and
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31
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To KKW, Chan KH, Ho J, Pang PKP, Ho DTY, Chang ACH, Seng CW, Yip CCY, Cheng VCC, Hung IFN, Yuen KY. Respiratory virus infection among hospitalized adult patients with or without clinically apparent respiratory infection: a prospective cohort study. Clin Microbiol Infect 2019; 25:1539-1545. [PMID: 31004768 PMCID: PMC7129190 DOI: 10.1016/j.cmi.2019.04.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/05/2019] [Accepted: 04/10/2019] [Indexed: 01/23/2023]
Abstract
Objectives To determine the viral epidemiology and clinical characteristics of patients with and without clinically apparent respiratory tract infection. Methods This prospective cohort study was conducted during the 2018 winter influenza season. Adult patients with fever/respiratory symptoms (fever/RS group) were age- and sex-matched with patients without fever/RS (non-fever/RS group) in a 1:1 ratio. Respiratory viruses were tested using NxTAG™ Respiratory Pathogen Panel IVD, a commercially-available multiplex PCR panel. Results A total of 214 acutely hospitalized patients were included in the final analysis, consisting of 107 with fever/RS (fever/RS group), and 107 age- and sex-matched patients without fever/RS (non-fever/RS group). Respiratory viruses were detected in 34.1% (73/214) of patients, and co-infection occurred in 7.9% (17/214) of patients. The incidence of respiratory virus was higher in the fever/RS group than in the non-fever/RS group (44.9% (48/107) versus 23.4% (25/107), p 0.001). Influenza B virus, enterovirus/rhinovirus and coronaviruses were detected more frequently in the fever/RS group, whereas parainfluenza virus 4B and adenovirus were detected more frequently in the non-fever/RS group. Among the non-fever/RS group, chest discomfort was more common among patients tested positive for respiratory viruses than those without respiratory virus detected (44% (11/25) versus 22% (18/82), p 0.04). Conclusions Respiratory viruses can be frequently detected among hospitalized patients without typical features of respiratory tract infection. These patients may be a source of nosocomial outbreaks.
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Affiliation(s)
- K K W To
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China; Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China; Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China; State Key Laboratory for Emerging Infectious Diseases, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - K-H Chan
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - J Ho
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - P K P Pang
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - D T Y Ho
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - A C H Chang
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - C W Seng
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - C C Y Yip
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China; Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China
| | - V C C Cheng
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China; Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China
| | - I F N Hung
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - K-Y Yuen
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China; Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China; Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China; State Key Laboratory for Emerging Infectious Diseases, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region, China.
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Radovanovic D, Sotgiu G, Jankovic M, Mahesh PA, Marcos PJ, Abdalla MI, Di Pasquale MF, Gramegna A, Terraneo S, Blasi F, Santus P, Aliberti S, Reyes LF, Restrepo MI. An international perspective on hospitalized patients with viral community-acquired pneumonia. Eur J Intern Med 2019; 60:54-70. [PMID: 30401576 PMCID: PMC7127340 DOI: 10.1016/j.ejim.2018.10.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/14/2018] [Accepted: 10/24/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Who should be tested for viruses in patients with community acquired pneumonia (CAP), prevalence and risk factors for viral CAP are still debated. We evaluated the frequency of viral testing, virus prevalence, risk factors and treatment coverage with oseltamivir in patients admitted for CAP. METHODS Secondary analysis of GLIMP, an international, multicenter, point-prevalence study of hospitalized adults with CAP. Testing frequency, prevalence of viral CAP and treatment with oseltamivir were assessed among patients who underwent a viral swab. Univariate and multivariate analysis was used to evaluate risk factors. RESULTS 553 (14.9%) patients with CAP underwent nasal swab. Viral CAP was diagnosed in 157 (28.4%) patients. Influenza virus was isolated in 80.9% of cases. Testing frequency and viral CAP prevalence were inhomogeneous across the participating centers. Obesity (OR 1.59, 95%CI: 1.01-2.48; p = 0.043) and need for invasive mechanical ventilation (OR 1.62, 95%CI: 1.02-2.56; p = 0.040) were independently associated with viral CAP. Prevalence of empirical treatment with oseltamivir was 5.1%. CONCLUSION In an international scenario, testing frequency for viruses in CAP is very low. The most common cause of viral CAP is Influenza virus. Obesity and need for invasive ventilation represent independent risk factors for viral CAP. Adherence to recommendations for treatment with oseltamivir is poor.
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Affiliation(s)
- Dejan Radovanovic
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Section of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Mateja Jankovic
- School of Medicine, University of Zagreb, Department for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, Croatia
| | - Padukudru Anand Mahesh
- Department of Pulmonary Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India
| | - Pedro Jorge Marcos
- Dirección de Procesos Asistenciales, Servicio de Neumología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), Estructura Organizativa de Xestion Integrada (EOXI) de A Coruña, SERGAS, Universidade da Coruña (UDC), A Coruña, Spain
| | - Mohamed I Abdalla
- South Texas Veterans Health Care System and University of Texas Health, San Antonio, TX, USA
| | - Marta Francesca Di Pasquale
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Gramegna
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Terraneo
- Department of Health Sciences, University of Milan, Milan, Italy; Department of Health Sciences, University of Milan, Respiratory Unit, San Paolo Hospital, Milan, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Section of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Stefano Aliberti
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Luis F Reyes
- Department of Microbiology, Universidad de La Sabana, Chia, Colombia
| | - Marcos I Restrepo
- South Texas Veterans Health Care System and University of Texas Health, San Antonio, TX, USA
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33
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The Culpability of Respiratory Viruses in Pneumonia-Related Acute Respiratory Failure. Chest 2018; 154:223. [DOI: 10.1016/j.chest.2018.01.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 01/05/2018] [Indexed: 11/17/2022] Open
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34
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Walter JM, Wunderink RG. Testing for Respiratory Viruses in Adults With Severe Lower Respiratory Infection. Chest 2018; 154:1213-1222. [PMID: 29908153 PMCID: PMC6224704 DOI: 10.1016/j.chest.2018.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/29/2018] [Accepted: 06/04/2018] [Indexed: 12/31/2022] Open
Abstract
Viral pathogens are a common cause of severe lower respiratory tract infection in adults. Our ability to rapidly and accurately identify viral infections has dramatically improved as slow culture-based techniques have been largely replaced by multiplex high-throughput systems. Given these advances, reevaluation of the role of respiratory viral testing in adults presenting with lower respiratory tract infection is important. This article reviews the potential benefits of testing, provides an overview of the most commonly used diagnostic techniques, and considers whether current evidence supports routine testing.
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Affiliation(s)
- James M Walter
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Richard G Wunderink
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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