Prevalence and clinical impact of VIral Respiratory tract infections in patients hospitalized for Community-Acquired Pneumonia: the VIRCAP study

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Intern Emerg Med. 2019 Nov 30. doi: 10.1007/s11739-019-02243-9. [Epub ahead of print] Prevalence and clinical impact of VIral Respiratory tract infections in patients hospitalized for Community-Acquired Pneumonia: the VIRCAP study.

Tatarelli P^1,2, Magnasco L³, Borghesi ML³, Russo C³, Marra A⁴, Mirabella M³, Sarteschi G³, Ungaro R³, Arcuri C⁵, Murialdo G⁴, Viscoli C³, Del Bono V⁶, Nicolini LA³.
Author information

1 Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Polyclinic Hospital and IRCCS, University of Genoa, Via Pastore, 1, 16132, Genoa, Italy. paolatatarelli@gmail.com. 2 Department of Infectious Diseases, Ospedale Santa Maria Delle Croci, Ravenna, Italy. paolatatarelli@gmail.com. 3 Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Polyclinic Hospital and IRCCS, University of Genoa, Via Pastore, 1, 16132, Genoa, Italy. 4 Second Clinic of Internal Medicine, Department of Internal Medicine, San Martino Polyclinic Hospital and IRCCS, University of Genoa, Genoa, Italy. 5 Department of Health Sciences (DiSSal), University of Genoa, Genoa, Italy. 6 Infectious Diseases Unit, Azienda Ospedaliera S. Croce E Carle, Cuneo, Italy.

Abstract

Prevalence and clinical impact of viral respiratory tract infections (VRTIs) on community-acquired pneumonia (CAP) has not been well defined so far. The aims of this study were to investigate the prevalence and the clinical impact of VRTIs in patients with CAP. Prospective study involving adult patients consecutively admitted at medical wards for CAP and tested for VRTIs by real-time PCR on pharyngeal swab. Patients' features were evaluated with regard to the presence of VRTI and aetiology of CAP. Clinical failure was a composite endpoint defined by worsening of signs and symptoms requiring escalation of antibiotic treatment or ICU admission or death within 30 days. 91 patients were enrolled, mean age 65.7 ? 10.6 years, 50.5% female. 62 patients (68.2%) had no viral co-infection while in 29 patients (31.8%) a VRTI was detected; influenza virus was the most frequently identified (41.9%). The two groups were similar in terms of baseline features. In presence of a VRTI, pneumonia severity index (PSI) was more frequently higher than 91 and patients had received less frequently pre-admission antibiotic therapy (adjusted OR 2.689, 95% CI 1.017-7.111, p = 0.046; adjusted OR 0.143, 95% CI 0.030-0.670, p = 0.014). Clinical failure and antibiotic therapy duration were similar with regards to the presence of VRTI and the aetiology of CAP. VRTIs can be detected in almost a third of adults with CAP; influenza virus is the most relevant one. VRTI was associated with higher PSI at admission, but it does not affect patients' outcome.


KEYWORDS:

Community-acquired pneumonia; Influenza; Pneumonia severity index; Viral respiratory tract infections

PMID: 31786751 DOI: 10.1007/s11739-019-02243-9