Voiriot Guillaume, Visseaux Benoit, Cohen Johana, Nguyen Liem Binh Luong, Neuville Mathilde, Morbieu Caroline, Burdet Charles, Radjou Aguila, Lescure François-Xavier, Smonig Roland, Armand-Lefèvre Laurence, Mourvillier Bruno, Yazdanpanah Yazdan, Soubirou Jean-Francois, Ruckly Stephane, Houhou-Fidouh Nadhira, Timsit Jean-François
Service de Réanimation Médicale et Infectieuse, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.
Hôpital Bichat Claude Bernard, 46 rue Henri Huchard, Paris, 75018, France.
Crit Care. 2016 Oct 25;20(1):375. doi: 10.1186/s13054-016-1517-9.
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.
多重聚合酶链反应（mPCR）能够从社区获得性肺炎（CAP）患者的气道中检测出病毒，但其临床影响仍不确定。
在一家重症监护病房（ICU）收治的成年患者中，对入院后72小时内接受mPCR检测的连续患者进行回顾性研究，纳入最终诊断为CAP的患者。分为四个病因组：细菌感染组、病毒感染组、混合感染组（病毒-细菌感染）和无明确病因组。采用复杂病程的综合标准（医院死亡或机械通气超过7天）。亚组分析比较了细菌感染组和病毒-细菌感染组中细菌病原体匹配的患者。
174例患者（132例男性[76%]，年龄63[53-75]岁，SAPSII 38[27;55]，PSI评分中位数106[78;130]）中，细菌感染组、病毒感染组、混合感染组和无明确病因组分别有46例（26%）、53例（31%）、45例（26%）和30例（17%）。病毒感染患者血清肌酸激酶水平较高，血小板计数较低，且肺泡-间质浸润更为常见。与细菌感染组（18/46，39%）、病毒感染组（15/53，28%）和无明确病因组（12/30，40%）相比，混合感染组（31/45，69%）复杂病程更为常见（p<0.01）。多因素分析显示，混合感染（病毒-细菌感染）与复杂病程独立相关（参考：细菌性肺炎；OR，3.58；95%CI，1.16-11；p=0.03）。细菌病原体匹配患者的亚组分析证实了这些结果。
成人重症CAP期间的病毒-细菌混合感染与临床表现受损和复杂病程相关。
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