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Predictors of viral pneumonia: The need for viral testing in all patients hospitalized for nursing home‐acquired pneumonia

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Predictors of viral pneumonia: The need for viral testing in all patients hospitalized for nursing home‐acquired pneumonia

Auteurs : Hon Ming Ma ; Kin Ping Lee ; Jean Woo

Source :

Geriatrics & Gerontology International [ 1444-1586 ] ; 2013.

RBID : PMC:7165925

Abstract

Aim

Community‐acquired pneumonia (CAP) is presumed to be bacterial in origin and empirical antibiotics are almost always given on admission. However, early detection of viral infection is also very important for hospital infection control and timely use of antiviral agents. The present study aimed to compare patients with viral and bacterial pneumonia, and identify independent predictors of viral pneumonia.

Methods

A prospective cohort study was carried out in a tertiary teaching hospital in a 1‐year period. Older patients (aged ≥65 years) were recruited if they were admitted for CAP confirmed by chest radiographs.

Results

A cohort of 488 patients was analyzed. Infective causes were found in 137 (28.1%) patients. Bacterial, viral and mixed infections were detected in 86 (17.6%), 41 (8.4%) and 10 (2.0%) patients, respectively. Bacteriology was established mostly by sputum culture and virology by nasopharyngeal aspirate (NPA) viral culture. The commonest bacterial isolates were Haemophilus influenzae (31), Pseudomonas aeruginosa (15), Mycobacterium tuberculosis (14), Klebsiella spp. (9) and Streptococcus pneumoniae (6). Influenza A virus (28, 8 were pandemic 2009 A/H1N1 subtype) and respiratory syncytial virus (16) were the most frequent viral causes. Independent predictors of viral pneumonia included nursing home residence (RR 3.056, P = 0.009) and absence of leukocytosis (RR 0.425, P = 0.026).

Conclusions

All nursing home residents hospitalized for CAP should undergo NPA viral testing because of infection control, early antiviral treatment and discharge planning. We suggest that empirical antiviral agents might be considered for nursing home residents hospitalized for CAP if outbreaks of influenza‐like illness are reported in nursing homes. Geriatr Gerontol Int 2013; 13: 949–957.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7165925

DOI: 10.1111/ggi.12036
PubMed: 23441872
PubMed Central: 7165925

Affiliations:

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PMC:7165925

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<front><div type="abstract" xml:lang="en"><sec id="ggi12036-sec-0001"><title>Aim</title>
<p>Community‐acquired pneumonia (<styled-content style="fixed-case" toggle="no">CAP</styled-content>
) is presumed to be bacterial in origin and empirical antibiotics are almost always given on admission. However, early detection of viral infection is also very important for hospital infection control and timely use of antiviral agents. The present study aimed to compare patients with viral and bacterial pneumonia, and identify independent predictors of viral pneumonia.</p>
</sec>
<sec id="ggi12036-sec-0002"><title>Methods</title>
<p>A prospective cohort study was carried out in a tertiary teaching hospital in a 1‐year period. Older patients (aged ≥65 years) were recruited if they were admitted for <styled-content style="fixed-case" toggle="no">CAP</styled-content>
 confirmed by chest radiographs.</p>
</sec>
<sec id="ggi12036-sec-0003"><title>Results</title>
<p>A cohort of 488 patients was analyzed. Infective causes were found in 137 (28.1%) patients. Bacterial, viral and mixed infections were detected in 86 (17.6%), 41 (8.4%) and 10 (2.0%) patients, respectively. Bacteriology was established mostly by sputum culture and virology by nasopharyngeal aspirate (<styled-content style="fixed-case" toggle="no">NPA</styled-content>
) viral culture. The commonest bacterial isolates were <italic><styled-content style="fixed-case" toggle="no">H</styled-content>
aemophilus influenzae</italic>
 (31), <italic><styled-content style="fixed-case" toggle="no">P</styled-content>
seudomonas aeruginosa</italic>
 (15), <italic><styled-content style="fixed-case" toggle="no">M</styled-content>
ycobacterium tuberculosis</italic>
 (14), <italic>Klebsiella</italic>
 spp. (9) and <italic><styled-content style="fixed-case" toggle="no">S</styled-content>
treptococcus pneumoniae</italic>
 (6). Influenza <styled-content style="fixed-case" toggle="no">A</styled-content>
 virus (28, 8 were pandemic 2009 <styled-content style="fixed-case" toggle="no">A/H1N1</styled-content>
 subtype) and respiratory syncytial virus (16) were the most frequent viral causes. Independent predictors of viral pneumonia included nursing home residence (<styled-content style="fixed-case" toggle="no">RR</styled-content>
 3.056, <italic>P</italic>
 = 0.009) and absence of leukocytosis (<styled-content style="fixed-case" toggle="no">RR</styled-content>
 0.425, <italic>P</italic>
 = 0.026).</p>
</sec>
<sec id="ggi12036-sec-0004"><title>Conclusions</title>
<p>All nursing home residents hospitalized for <styled-content style="fixed-case" toggle="no">CAP</styled-content>
 should undergo <styled-content style="fixed-case" toggle="no">NPA</styled-content>
 viral testing because of infection control, early antiviral treatment and discharge planning. We suggest that empirical antiviral agents might be considered for nursing home residents hospitalized for <styled-content style="fixed-case" toggle="no">CAP</styled-content>
 if outbreaks of influenza‐like illness are reported in nursing homes. <bold>Geriatr Gerontol Int 2013; 13: 949–957.</bold>
</p>
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  <front><journal-meta><journal-id journal-id-type="nlm-ta">Geriatr Gerontol Int</journal-id>
<journal-id journal-id-type="iso-abbrev">Geriatr Gerontol Int</journal-id>
<journal-id journal-id-type="doi">10.1111/(ISSN)1447-0594</journal-id>
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<issn pub-type="epub">1447-0594</issn>
<publisher><publisher-name>John Wiley and Sons Inc.</publisher-name>
<publisher-loc>Hoboken</publisher-loc>
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<article-meta><article-id pub-id-type="pmid">23441872</article-id>
<article-id pub-id-type="pmc">7165925</article-id>
<article-id pub-id-type="doi">10.1111/ggi.12036</article-id>
<article-id pub-id-type="publisher-id">GGI12036</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Original Articles: Epidemiology, Clinical Practice and Health</subject>
</subj-group>
<subj-group subj-group-type="overline"><subject>Original Article: Epidemiology, Clinical Practice and Health</subject>
</subj-group>
</article-categories>
<title-group><article-title>Predictors of viral pneumonia: The need for viral testing in all patients hospitalized for nursing home‐acquired pneumonia</article-title>
<alt-title alt-title-type="right-running-head">Viral infection in NHAP</alt-title>
<alt-title alt-title-type="left-running-head">HM Ma <italic>et al</italic>
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<contrib-group><contrib id="ggi12036-cr-0001" contrib-type="author" corresp="yes"><name><surname>Ma</surname>
<given-names>Hon Ming</given-names>
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<xref ref-type="aff" rid="ggi12036-aff-0001"><sup>1</sup>
</xref>
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<contrib id="ggi12036-cr-0002" contrib-type="author"><name><surname>Lee</surname>
<given-names>Kin Ping</given-names>
</name>
<xref ref-type="aff" rid="ggi12036-aff-0002"><sup>2</sup>
</xref>
</contrib>
<contrib id="ggi12036-cr-0003" contrib-type="author"><name><surname>Woo</surname>
<given-names>Jean</given-names>
</name>
<xref ref-type="aff" rid="ggi12036-aff-0001"><sup>1</sup>
</xref>
</contrib>
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<aff id="ggi12036-aff-0001"><label><sup>1</sup>
</label>
<named-content content-type="organisation-division">Department of Medicine and Therapeutics</named-content>
<institution>Prince of Wales Hospital</institution>
<institution>The Chinese University of Hong Kong</institution>
<city>Hong Kong SAR</city>
<country country="CN">China</country>
</aff>
<aff id="ggi12036-aff-0002"><label><sup>2</sup>
</label>
<named-content content-type="organisation-division">Department of Microbiology</named-content>
<institution>Prince of Wales Hospital</institution>
<institution>The Chinese University of Hong Kong</institution>
<city>Hong Kong SAR</city>
<country country="CN">China</country>
</aff>
<author-notes><corresp id="correspondenceTo"><label>*</label>
Correspondence: Dr Ma Hon Ming MBChB MRCP MSc MPH, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China. Email: <email>hmma@cuhk.edu.hk</email>
</corresp>
</author-notes>
<pub-date pub-type="epub"><day>26</day>
<month>2</month>
<year>2013</year>
</pub-date>
<pub-date pub-type="ppub"><month>10</month>
<year>2013</year>
</pub-date>
<volume>13</volume>
<issue>4</issue>
<issue-id pub-id-type="doi">10.1111/ggi.2013.13.issue-4</issue-id>
<fpage>949</fpage>
<lpage>957</lpage>
<history><date date-type="accepted"><day>13</day>
<month>12</month>
<year>2012</year>
</date>
</history>
<permissions><pmc-comment> Copyright © 2013 Japan Geriatrics Society </pmc-comment>
        <copyright-statement content-type="article-copyright">© 2013 Japan Geriatrics Society</copyright-statement>
<license><license-p>This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.</license-p>
</license>
</permissions>
<self-uri content-type="pdf" xlink:href="file://GGI-13-949.pdf"></self-uri>
<abstract><sec id="ggi12036-sec-0001"><title>Aim</title>
<p>Community‐acquired pneumonia (<styled-content style="fixed-case" toggle="no">CAP</styled-content>
) is presumed to be bacterial in origin and empirical antibiotics are almost always given on admission. However, early detection of viral infection is also very important for hospital infection control and timely use of antiviral agents. The present study aimed to compare patients with viral and bacterial pneumonia, and identify independent predictors of viral pneumonia.</p>
</sec>
<sec id="ggi12036-sec-0002"><title>Methods</title>
<p>A prospective cohort study was carried out in a tertiary teaching hospital in a 1‐year period. Older patients (aged ≥65 years) were recruited if they were admitted for <styled-content style="fixed-case" toggle="no">CAP</styled-content>
 confirmed by chest radiographs.</p>
</sec>
<sec id="ggi12036-sec-0003"><title>Results</title>
<p>A cohort of 488 patients was analyzed. Infective causes were found in 137 (28.1%) patients. Bacterial, viral and mixed infections were detected in 86 (17.6%), 41 (8.4%) and 10 (2.0%) patients, respectively. Bacteriology was established mostly by sputum culture and virology by nasopharyngeal aspirate (<styled-content style="fixed-case" toggle="no">NPA</styled-content>
) viral culture. The commonest bacterial isolates were <italic><styled-content style="fixed-case" toggle="no">H</styled-content>
aemophilus influenzae</italic>
 (31), <italic><styled-content style="fixed-case" toggle="no">P</styled-content>
seudomonas aeruginosa</italic>
 (15), <italic><styled-content style="fixed-case" toggle="no">M</styled-content>
ycobacterium tuberculosis</italic>
 (14), <italic>Klebsiella</italic>
 spp. (9) and <italic><styled-content style="fixed-case" toggle="no">S</styled-content>
treptococcus pneumoniae</italic>
 (6). Influenza <styled-content style="fixed-case" toggle="no">A</styled-content>
 virus (28, 8 were pandemic 2009 <styled-content style="fixed-case" toggle="no">A/H1N1</styled-content>
 subtype) and respiratory syncytial virus (16) were the most frequent viral causes. Independent predictors of viral pneumonia included nursing home residence (<styled-content style="fixed-case" toggle="no">RR</styled-content>
 3.056, <italic>P</italic>
 = 0.009) and absence of leukocytosis (<styled-content style="fixed-case" toggle="no">RR</styled-content>
 0.425, <italic>P</italic>
 = 0.026).</p>
</sec>
<sec id="ggi12036-sec-0004"><title>Conclusions</title>
<p>All nursing home residents hospitalized for <styled-content style="fixed-case" toggle="no">CAP</styled-content>
 should undergo <styled-content style="fixed-case" toggle="no">NPA</styled-content>
 viral testing because of infection control, early antiviral treatment and discharge planning. We suggest that empirical antiviral agents might be considered for nursing home residents hospitalized for <styled-content style="fixed-case" toggle="no">CAP</styled-content>
 if outbreaks of influenza‐like illness are reported in nursing homes. <bold>Geriatr Gerontol Int 2013; 13: 949–957.</bold>
</p>
</sec>
</abstract>
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<tree><noCountry><name sortKey="Lee, Kin Ping" sort="Lee, Kin Ping" uniqKey="Lee K" first="Kin Ping" last="Lee">Kin Ping Lee</name>
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Predictors of viral pneumonia: The need for viral testing in all patients hospitalized for nursing home‐acquired pneumonia

Predictors of viral pneumonia: The need for viral testing in all patients hospitalized for nursing home‐acquired pneumonia

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Abstract

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