TY - JOUR
T1 - The Burden of Viruses in Pneumonia Associated With Acute Respiratory Failure
T2 - An Underappreciated Issue
AU - Shorr, Andrew F.
AU - Fisher, Kristen
AU - Micek, Scott T.
AU - Kollef, Marin H.
N1 - Funding Information:
Financial/nonfinancial disclosures: The authors have reported to CHEST the following: M. H. K. is supported by the by the BJC Healthcare Foundation. A. F. S. has received research support from, served as a consultant to, or been a speaker for Accelerate, Achaogen, Alios, Allergan, Aridis, Astellas, AstraZeneca, Bayer, Cidara, Entasys, MedCo, Melinta, Merck, Nabriva, Paratek, and Tetraphase. None declared (K. F., S. T. M.).
Publisher Copyright:
© 2017 American College of Chest Physicians
PY - 2018/7
Y1 - 2018/7
N2 - Background: Pneumonia associated with mechanical ventilation (MV) results in substantial mortality and represents a leading reason for the use of antibiotics. The role of viruses in this setting is unclear. Identifying a viral cause in such instances could facilitate antibiotic stewardship. Methods: We performed a secondary analysis of a prospective cohort with pneumonia requiring MV. We included both cases occurring in the community and hospital-onset cases and classified patients according to the cause of the pneumonia. The prevalence of viral pathogens represented the primary end point. We identified variables independently associated with isolation of a viral organism as the sole pathogen. Results: The cohort included 364 patients, and a virus was the sole pathogen in 79 cases (21.7%). The most common viruses included rhinovirus/enterovirus (n = 20), influenza A (n = 12), and respiratory syncytial virus (n = 11). The rate of in-hospital death was high (37.2%) and did not differ from that seen in other patients (36.5%). The duration of MV, hospital length of stay, and 30-day readmission rates also did not differ based on the cause of pneumonia. Two variables were independently associated with recovery of a virus: an Acute Physiology and Health Evaluation II score of < 26 (adjusted odds ratio [AOR], 0.51; 95% CI, 0.28-0.93; P =.027) and stem cell transplantation (SCT) (AOR, 4.39; 95% CI, 2.03-9.50; P =.001). A sensitivity analysis excluding patients who underwent SCT did not substantially alter our observations. Conclusions: Viruses represent a major cause of pneumonia in critically ill patients requiring MV. Identifying such subjects presents an opportunity for discontinuing antibiotics. Clinicians should consider systematically evaluating patients with pneumonia requiring MV for viral pathogens.
AB - Background: Pneumonia associated with mechanical ventilation (MV) results in substantial mortality and represents a leading reason for the use of antibiotics. The role of viruses in this setting is unclear. Identifying a viral cause in such instances could facilitate antibiotic stewardship. Methods: We performed a secondary analysis of a prospective cohort with pneumonia requiring MV. We included both cases occurring in the community and hospital-onset cases and classified patients according to the cause of the pneumonia. The prevalence of viral pathogens represented the primary end point. We identified variables independently associated with isolation of a viral organism as the sole pathogen. Results: The cohort included 364 patients, and a virus was the sole pathogen in 79 cases (21.7%). The most common viruses included rhinovirus/enterovirus (n = 20), influenza A (n = 12), and respiratory syncytial virus (n = 11). The rate of in-hospital death was high (37.2%) and did not differ from that seen in other patients (36.5%). The duration of MV, hospital length of stay, and 30-day readmission rates also did not differ based on the cause of pneumonia. Two variables were independently associated with recovery of a virus: an Acute Physiology and Health Evaluation II score of < 26 (adjusted odds ratio [AOR], 0.51; 95% CI, 0.28-0.93; P =.027) and stem cell transplantation (SCT) (AOR, 4.39; 95% CI, 2.03-9.50; P =.001). A sensitivity analysis excluding patients who underwent SCT did not substantially alter our observations. Conclusions: Viruses represent a major cause of pneumonia in critically ill patients requiring MV. Identifying such subjects presents an opportunity for discontinuing antibiotics. Clinicians should consider systematically evaluating patients with pneumonia requiring MV for viral pathogens.
KW - acute respiratory failure
KW - bacteria
KW - outcomes
KW - pneumonia
KW - virus
UR - http://www.scopus.com/inward/record.url?scp=85044530687&partnerID=8YFLogxK
U2 - 10.1016/j.chest.2017.12.005
DO - 10.1016/j.chest.2017.12.005
M3 - Article
C2 - 29274318
AN - SCOPUS:85044530687
SN - 0012-3692
VL - 154
SP - 84
EP - 90
JO - CHEST
JF - CHEST
IS - 1
ER -