Department of Infectious Diseases, Skaraborg Hospital, 541 85, Skövde, Sweden.
CARe (Center for Antibiotic Resistance Research), Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
Eur J Clin Microbiol Infect Dis. 2017 Oct;36(10):1767-1776. doi: 10.1007/s10096-017-2990-z. Epub 2017 May 17.
The study aim was to investigate the prevalence and clinical relevance of viral findings by multiplex PCR from the nasopharynx of clinically septic patients during a winter season. During 11 weeks of the influenza epidemic period in January-March 2012, consecutive adult patients suspected to be septic (n = 432) were analyzed with cultures from blood and nasopharynx plus multiplex PCR for respiratory viruses on the nasopharyngeal specimen. The results were compared with those from microbiology analyses ordered as part of standard care. During the winter season, viral respiratory pathogens, mainly influenza A virus, human metapneumovirus, coronavirus, and respiratory syncytial virus were clinically underdiagnosed in 70% of patients positive by the multiplex PCR assay. During the first four weeks of the influenza epidemic, few tests for influenza were ordered by clinicians, indicating low awareness that the epidemic had started. Nasopharyngeal findings of Streptococcus pneumoniae and Haemophilus influenzae by culture correlated to pneumonia diagnosis, and in those patients laboratory signs of viral co-infections were common but rarely suspected by clinicians. The role of respiratory viral infections in patients presenting with a clinical picture of sepsis is underestimated. Specific antiviral treatment might be beneficial in some cases and may reduce spread in a hospital setting. Diagnosing viral infections may promote reduction of unnecessary antibiotic use. It can also be a tool for decisions concerning patient logistics, in order to minimize exposure of susceptible patients and personnel.
本研究旨在调查冬季临床疑似败血症患者鼻咽部分离物中多重 PCR 检测到的病毒检出率及其临床相关性。2012 年 1 月至 3 月流感流行期间的 11 周内，连续分析了 432 例疑似败血症的成年患者，检测血培养、鼻咽培养和呼吸道病毒多重 PCR。结果与作为标准护理一部分而进行的微生物学分析进行了比较。在冬季，病毒呼吸道病原体（主要为甲型流感病毒、人类偏肺病毒、冠状病毒和呼吸道合胞病毒）在多重 PCR 检测阳性的 70%患者中被临床低估。在流感流行的前四周，临床医生很少开流感检测，这表明他们对流感的流行开始认识不足。通过培养检测到的肺炎链球菌和流感嗜血杆菌的鼻咽部发现与肺炎诊断相关，在这些患者中，病毒合并感染的实验室指标常见，但临床医生很少怀疑。在表现为败血症临床症状的患者中，呼吸道病毒感染的作用被低估。在某些情况下，使用抗病毒治疗可能有益，并可减少医院环境中的传播。诊断病毒感染可能有助于减少不必要的抗生素使用。它还可以作为决策患者流程的工具，以尽量减少易感患者和人员的暴露。
