Laboratoire de Virologie, Institut des Agents Infectieux, Groupement Hospitalier Nord des Hospices Civils de Lyon, Lyon, France.
CIRI, Centre International de Recherche en Infectiologie, Virpath, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Univ Lyon, Lyon, France.
Eur J Clin Microbiol Infect Dis. 2019 Jan;38(1):157-160. doi: 10.1007/s10096-018-3407-3. Epub 2018 Oct 23.
Respiratory syncytial virus (RSV) has been recognized as responsible for severe respiratory illness in adults, especially in the elderly. While pneumonia is commonly observed during RSV infection, the burden and epidemiology of bacterial superinfection is poorly understood. The aim of this study was to identify microorganisms associated with RSV-positive pneumonia in adults. A retrospective study was conducted during three consecutive winters (October to April 2013-2016) in the University Hospital of Lyon, France. During RSV circulation periods, a systematic RSV screening was performed by reverse-transcription PCR on all respiratory samples collected from adults. Records of RSV-positive patients were subsequently analyzed to identify radiologically confirmed pneumonia cases. Bacteria were identified by standard bacteriology cultures or urinary antigen screening and classified as potentially causative of pneumonia if quantification was above the specific threshold as defined by the European Manual of Clinical Microbiology. Overall, 14,792 adult respiratory samples were screened for RSV detection by PCR. In total, 292 had a positive RSV detection (2.0%) among which 89 presented with pneumonia including 27 bacterial superinfections (9.3%) with Streptococcus pneumonia, Haemophilus influenza, Staphylococcus aureus, Pseudomonas aeruginosa, and Moraxella catarrhalis. Most patients were elderly (55.6%) and patients with comorbidities (77.8%). A more severe outcome was observed for RSV-bacteria-associated pneumonia compared with RSV pneumonia: length of stay was significantly longer (16 days vs 10 days) and ICU hospitalization more frequent (66.7% vs 21.0%) (p < 0.05). In conclusion, we did not observe major differences in the epidemiology of bacterial superinfections in RSV-positive pneumonia compared to reports on post-influenza pneumonia.
呼吸道合胞病毒（RSV）已被认为是导致成人严重呼吸道疾病的罪魁祸首，尤其是老年人。虽然在 RSV 感染期间常观察到肺炎，但对细菌合并感染的负担和流行病学知之甚少。本研究旨在确定与成人 RSV 阳性肺炎相关的微生物。在法国里昂大学医院进行了一项回顾性研究，时间为三个连续的冬季（2013 年至 2016 年 10 月至 4 月）。在 RSV 流行期间，对所有来自成人的呼吸道样本进行了逆转录 PCR 系统 RSV 筛查。随后对 RSV 阳性患者的记录进行分析，以确定影像学确诊的肺炎病例。通过标准细菌培养或尿抗原筛查鉴定细菌，并将定量超过欧洲临床微生物学手册定义的特定阈值的细菌分类为可能引起肺炎的病原体。总体而言，通过 PCR 对 14792 例成人呼吸道样本进行了 RSV 检测筛查。共有 292 例 RSV 检测呈阳性（2.0%），其中 89 例出现肺炎，包括 27 例细菌合并感染（9.3%），病原体包括肺炎链球菌、流感嗜血杆菌、金黄色葡萄球菌、铜绿假单胞菌和卡他莫拉菌。大多数患者为老年人（55.6%）和合并症患者（77.8%）。与 RSV 肺炎相比，RSV-细菌相关肺炎的预后更差：住院时间明显更长（16 天 vs. 10 天），入住 ICU 更频繁（66.7% vs. 21.0%）（p<0.05）。总之，与流感后肺炎的报告相比，我们没有观察到 RSV 阳性肺炎中细菌合并感染的流行病学有重大差异。
