Viral infection in adults hospitalized with community-acquired pneumonia: prevalence, pathogens, and presentation.
Viral infection in adults hospitalized with community-acquired pneumonia: prevalence, pathogens, and presentation.
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患有社区获得性肺炎的成年人的病毒感染：患病率，病原体和表现。
DOI：
10.1378/chest.08-0888
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发表时间：
2008-12
期刊：
影响因子：
9.6
通讯作者：
Marrie TJ
中科院分区：
文献类型：
--
作者：
Johnstone J;Majumdar SR;Fox JD;Marrie TJ
自核酸扩增检测（NAT）出现以来，呼吸道病毒在成人社区获得性肺炎（CAP）自然史中的潜在作用尚未得到很好的描述。 2004年至2006年期间，前瞻性地将五家医院收治的CAP成人纳入研究，并获得了临床数据、培养物、血清学和鼻咽拭子。对拭子中的 NAT 进行了流感、人类偏肺病毒 (hMPV)、呼吸道合胞病毒 (RSV)、鼻病毒、副流感病毒 1-4、冠状病毒（OC43、229E 和 NL63）和腺病毒的检测。总共纳入193名患者；中位年龄为 71 岁，51% 的患者为男性，47% 的患者患有严重的 CAP。总体而言，75 名患者 (39%) 发现了病原体。这些病原体中，29种为病毒（15%），38种为细菌（20%），8种为混合（4%），其余为“未知”。流感 (n = 7)、hMPV (n = 7) 和 RSV (n = 5) 是大多数病毒感染的原因；其他感染包括鼻病毒 (n = 4)、副流感病毒 (n = 3)、冠状病毒 (n = 4) 和腺病毒 (n = 2)。肺炎链球菌是最常见的细菌感染（37%）。与细菌感染相比，病毒感染患者年龄更大（分别为 76 岁 vs 64 岁；p = 0.01），更有可能患有心脏病（分别为 66% vs 32%；p = 0.006），并且更虚弱（例如，48% 的患者活动受限，而细菌感染的患者为 21%；p = 0.02）。根据是否存在病毒感染，表现上几乎没有临床意义的差异，并且结果没有差异。病毒感染在成人肺炎患者中很常见。流感、hMPV 和 RSV 等容易传播的病毒是最常见的，引发了人们对感染控制的担忧。对于因肺炎住院的成年人，可能需要进行呼吸道病毒的常规检测。
The potential role of respiratory viruses in the natural history of community-acquired pneumonia (CAP) in adults has not been well described since the advent of nucleic amplification tests (NATs). From 2004 to 2006, adults with CAP who were admitted to five hospitals were prospectively enrolled in the study, and clinical data, cultures, serology, and nasopharyngeal swabs were obtained. NATs from swabs were tested for influenza, human metapneumovirus (hMPV), respiratory syncytial virus (RSV), rhinovirus, parainfluenza virus 1–4, coronaviruses (OC43, 229E, and NL63), and adenovirus. A total of 193 patients were included; the median age was 71 years, 51% of patients were male, and 47% of patients had severe CAP. Overall, 75 patients (39%) had a pathogen identified. Of these pathogens, 29 were viruses (15%), 38 were bacteria (20%), 8 were mixed (4%), and the rest were “unknown.” Influenza (n = 7), hMPV (n = 7), and RSV (n = 5) accounted for most viral infections; other infections included rhinovirus (n = 4), parainfluenza (n = 3), coronavirus (n = 4), and adenovirus (n = 2). Streptococcus pneumoniae was the most common bacterial infection (37%). Compared with bacterial infection, patients with viral infection were older (76 vs 64 years, respectively; p = 0.01), were more likely to have cardiac disease (66% vs 32%, respectively; p = 0.006), and were more frail (eg, 48% with limited ambulation vs 21% of bacterial infections; p = 0.02). There were few clinically meaningful differences in presentation and no differences in outcomes according to the presence or absence of viral infection. Viral infections are common in adults with pneumonia. Easily transmissible viruses such as influenza, hMPV, and RSV were the most common, raising concerns about infection control. Routine testing for respiratory viruses may be warranted for adults who have been hospitalized with pneumonia.
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