Acute Crit Care.  2022 Nov;37(4):550-560. 10.4266/acc.2022.00682.

The frequency and seasonal distribution of viral infection in patients with community-acquired pneumonia and its impact on the prognosis

• Kim KJ
• Kim DH

• KMID: 2540143
• DOI: http://doi.org/10.4266/acc.2022.00682

Abstract

Background
Studies on the effects of viral coinfection on bacterial pneumonia are still scarce in South Korea. This study investigates the frequency and seasonal distribution of virus infection and its impact on the prognosis in patients with community-acquired pneumonia (CAP). Methods: The medical records of CAP patients with definite etiology, such as viruses and bacteria, were retrospectively reviewed. Their epidemiologic and clinical characteristics, microbiologic test results, the severity of illness, and 30-day mortality were analyzed. Results: Among 150 study subjects, 68 patients (45.3%) had viral infection alone, 47 (31.3%) had bacterial infection alone, and 35 (23.3%) had viral-bacterial coinfection, respectively. Among 103 patients with viral infections, Influenza A virus (44%) was the most common virus, followed by rhinovirus (19%), influenza B (13%), and adenovirus (6%). The confusion-urea-respiratory rateblood pressure-age of 65 (CURB-65) score of the viral-bacterial coinfection was higher than that of the viral infection (median [interquartile range]: 2.0 [1.0–4.0] vs. 2.0 [0.3–3.0], P=0.029). The 30-day mortality of the viral infection alone group (2.9%) was significantly lower than that of bacterial infection alone (19.1%) and viral-bacterial coinfection (25.7%) groups (Bonferroni-corrected P<0.05). Viral-bacterial coinfection was the stronger predictor of 30-day mortality in CAP (odds ratio [OR], 18.9; 95% confidence interval [CI], 3.0–118.3; P=0.002) than bacterial infection alone (OR, 6.3; 95% CI, 1.1–36.4; P=0.041), compared to viral infection alone on the multivariate analysis. Conclusions: The etiology of viral infection in CAP is different according to regional characteristics. Viral-bacterial coinfection showed a worse prognosis than bacterial infection alone in patients with CAP.

Keyword

community-acquired pneumonia; prognosis; virus; viral pneumonia

Figure

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  Figure 1. Flowchart of patient enrollment. CAP: community–acquired pneumonia; RT–PCR: reverse transcriptase polymerase chain reaction.

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  Figure 2. The frequency of causative respiratory viruses detected by reverse transcriptase polymerase chain reaction tests. Values are presented as the percentage of viruses detected from patients. RSV: respiratory syncytial virus.

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  Figure 3. The monthly distribution of the six most common respiratory viruses accounts for more than 5%. Values are presented as the number of detected cases.

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  Figure 4. The frequency of causative bacteria from bacterial cultures, urinary antigen tests, and immunoglobulin M antibodies. Values are presented as the number of isolated cases. MRSA: methicillin-resistant Staphylococcus aureus; MSSA: Methicillin–susceptible Staphylococcus aureus.

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