Viral-bacterial coinfection affects the presentation and alters the prognosis of severe community-acquired pneumonia.
Viral-bacterial coinfection affects the presentation and alters the prognosis of severe community-acquired pneumonia.
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DOI：
10.1186/s13054-016-1517-9
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发表时间：
2016-10-25
期刊：
影响因子：
--
通讯作者：
Timsit JF
中科院分区：
文献类型：
--
作者：
Voiriot G;Visseaux B;Cohen J;Nguyen LB;Neuville M;Morbieu C;Burdet C;Radjou A;Lescure FX;Smonig R;Armand-Lefèvre L;Mourvillier B;Yazdanpanah Y;Soubirou JF;Ruckly S;Houhou-Fidouh N;Timsit JF
多重聚合酶链反应（mPCR）能够从社区获得性肺炎（CAP）患者的呼吸道中恢复病毒，尽管其临床影响仍不确定。在重症监护病房（ICU）入院后72小时内连续接受mPCR的成年患者中，我们回顾性地纳入了最终诊断为CAP的患者。四种病因组聚集在一起：细菌性、病毒性、混合性（病毒-细菌）和无病因学。采用复杂病程（医院死亡或机械通气bbb7 d）的综合标准。亚组分析比较了细菌性和病毒性细菌性CAP与细菌性病原体匹配的患者。174例患者中（男性132例[76%]，年龄63[53 - 75]岁，SAPSII 38 [27;55]， PSI中位评分106[78；130]），细菌、病毒、混合和无病因组分别为46例（26%）、53例（31%）、45例（26%）和30例（17%）。病毒感染的患者表现为血清肌酸激酶水平高，血小板计数低，肺泡间质浸润更频繁。混合组并发症发生率（31/ 45,69 %）高于细菌组（18/ 46,39 %）、病毒组（15/ 53,28 %）和无病因组（12/ 30,40 %）（p < 0.01）。在多变量分析中，混合（病毒-细菌）感染与复杂病程独立相关（参考文献：细菌性肺炎；OR, 3.58; CI 95%, 1.16-11; p = 0.03）。细菌匹配患者的亚组分析证实了这些发现。成人重症CAP患者的病毒-细菌合并感染表现不佳，病程复杂。本文的在线版本（doi:10.1186/s13054-016-1517-9）包含补充材料，仅供授权用户使用。
Multiplex polymerase chain reaction (mPCR) enables recovery of viruses from airways of patients with community-acquired pneumonia (CAP), although their clinical impact remains uncertain. Among consecutive adult patients who had undergone a mPCR within 72 hours following their admission to one intensive care unit (ICU), we retrospectively included those with a final diagnosis of CAP. Four etiology groups were clustered: bacterial, viral, mixed (viral-bacterial) and no etiology. A composite criterion of complicated course (hospital death or mechanical ventilation > 7 days) was used. A subgroup analysis compared patients with bacterial and viral-bacterial CAP matched on the bacterial pathogens. Among 174 patients (132 men [76 %], age 63 [53–75] years, SAPSII 38 [27;55], median PSI score 106 [78;130]), bacterial, viral, mixed and no etiology groups gathered 46 (26 %), 53 (31 %), 45 (26 %) and 30 (17 %) patients, respectively. Virus-infected patients displayed a high creatine kinase serum level, a low platelet count, and a trend toward more frequent alveolar-interstitial infiltrates. A complicated course was more frequent in the mixed group (31/45, 69 %), as compared to bacterial (18/46, 39 %), viral (15/53, 28 %) and no etiology (12/30, 40 %) groups (p < 0.01). In multivariate analysis, the mixed (viral-bacterial) infection was independently associated with complicated course (reference: bacterial pneumonia; OR, 3.58; CI 95 %, 1.16–11; p = 0.03). The subgroup analysis of bacteria-matched patients confirmed these findings. Viral-bacterial coinfection during severe CAP in adults is associated with an impaired presentation and a complicated course. The online version of this article (doi:10.1186/s13054-016-1517-9) contains supplementary material, which is available to authorized users.
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DOI：
10.1186/cc10444
发表时间：
2011
期刊：
Critical care (London, England)
影响因子：
--
作者：
Cillóniz C;Ewig S;Ferrer M;Polverino E;Gabarrús A;Puig de la Bellacasa J;Mensa J;Torres A
通讯作者：
Torres A
DOI：
10.1016/s0140-6736(10)61459-6
发表时间：
2011-04-09
期刊：
Lancet (London, England)
影响因子：
--
作者：
Ruuskanen O;Lahti E;Jennings LC;Murdoch DR
通讯作者：
Murdoch DR
患有社区获得性肺炎的成年人的呼吸道病毒。
影响因子：
9.6
作者：
Lieberman D;Shimoni A;Shemer-Avni Y;Keren-Naos A;Shtainberg R;Lieberman D
通讯作者：
Lieberman D
影响因子：
158.5
作者：
DeVincenzo, John P.;Whitley, Richard J.;Chien, Jason W.
通讯作者：
Chien, Jason W.
影响因子：
6.4
作者：
Iverson, Amy R.;Boyd, Kelli L.;McCullers, Jonathan A.
通讯作者：
McCullers, Jonathan A.