Predictors of viral pneumonia: The need for viral testing in all patients hospitalized for nursing home‐acquired pneumonia
Open Access
- 26 February 2013
- journal article
- research article
- Published by Wiley in Geriatrics & Gerontology International
- Vol. 13 (4), 949-957
- https://doi.org/10.1111/ggi.12036
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.Keywords
This publication has 20 references indexed in Scilit:
- Role of ‘atypical pathogens’ among adult hospitalized patients with community‐acquired pneumoniaRespirology, 2009
- Development of a prognostic index for 90-day mortality in patients discharged after admission to hospital for community-acquired pneumoniaThorax, 2009
- Epidemiology and clinical outcomes of community-acquired pneumonia in adult patients in Asian countries: a prospective study by the Asian network for surveillance of resistant pathogensInternational Journal of Antimicrobial Agents, 2007
- An Outbreak of Severe Respiratory Tract Infection Due to Human Metapneumovirus in a Long-Term Care FacilityClinical Infectious Diseases, 2007
- Do Type and Duration of Antiretroviral Therapy Attenuate Liver Fibrosis in HIV--Hepatitis C Virus--Coinfected Patients?Clinical Infectious Diseases, 2006
- Two Outbreaks of Severe Respiratory Disease in Nursing Homes Associated with RhinovirusJournal of the American Geriatrics Society, 2005
- Sputum bacteriology in patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease and concomitant pneumonia in Hong KongInternal Medicine Journal, 2005
- Rhinovirus Outbreak in a Long Term Care Facility for Elderly Persons Associated with Unusually High MortalityClinical Infectious Diseases, 2005
- Do smoking parents seek the best advice for their asthmatic children?Thorax, 2001
- A hospital study of community acquired pneumonia in the elderly.Thorax, 1990