Department of Clinical Microbiology, CUB-Erasme, Université Libre de Bruxelles, Brussels, Belgium.
Department of Clinical Microbiology, AZ St-Jan Brugge-Oostende Hospital, Bruges, Belgium.
Eur J Clin Microbiol Infect Dis. 2019 Aug;38(8):1507-1514. doi: 10.1007/s10096-019-03579-y. Epub 2019 May 20.
The prevalence of respiratory viruses in immunocompromised adult patients and the association with clinical outcomes is still underexplored. Our goal was to assess the epidemiology and the potential clinical impact of respiratory viral infections in a high-risk patient population. Two large hospitals performed a respiratory Taqman array card (TAC), targeting 24 viruses, 8 bacteria, and 2 fungi simultaneously, on 435 samples from 397 symptomatic immunocompromised patients. Clinical details were collected retrospectively using a structured case report form. An overall positivity rate of 68% was found (51% mono- and 17% co-infections). Pathogen distribution was as follows: influenza A (20.7%), rhinoviruses (15.2%), coronaviruses (7.8%), Pneumocystis jirovecii (7.4%), RSV (7.1%), and CMV (6.0%) were the most frequently encountered, followed by HSV (5.5%), hMPV (4.4%), parainfluenza viruses (3.9%), influenza B (3.7%), and Aspergillus species (3.7%). Other pathogens were not detected or detected only in ≤ 1% of samples. Hospital and ICU admission rates were 84% and 11%, respectively. The presence of a pathogen was strongly associated with higher need for supplemental oxygen (p = 0.001), but it had no impact on ICU admission, mechanical ventilation requirement, antibacterial therapy, or mortality. In conclusion, our study described the epidemiology of respiratory pathogens in a large group of symptomatic immunocompromised patients and provides evidence of a relationship between pathogen detection and the need for supplemental oxygen. This association was still found after the exclusion of the results positive for influenza viruses, suggesting that non-influenza viruses contribute to severe respiratory illness in patients with compromised immunity.
免疫功能低下的成年患者中呼吸道病毒的流行情况及其与临床结局的关系仍未得到充分研究。我们的目标是评估高危患者人群中呼吸道病毒感染的流行病学和潜在临床影响。两家大型医院对 397 例有症状的免疫功能低下患者的 435 份样本同时进行了呼吸道 Taqman 阵列卡（TAC）检测，该检测针对 24 种病毒、8 种细菌和 2 种真菌。使用结构化病例报告表回顾性收集临床详细信息。发现总体阳性率为 68%（51%为单一感染，17%为混合感染）。病原体分布如下：甲型流感（20.7%）、鼻病毒（15.2%）、冠状病毒（7.8%）、卡氏肺孢子虫（7.4%）、呼吸道合胞病毒（7.1%）和巨细胞病毒（6.0%）最为常见，其次是单纯疱疹病毒（5.5%）、人偏肺病毒（4.4%）、副流感病毒（3.9%）、乙型流感（3.7%）和曲霉属（3.7%）。其他病原体未检出或仅在≤1%的样本中检出。住院和入住 ICU 的比例分别为 84%和 11%。病原体的存在与更高的补充氧气需求强烈相关（p=0.001），但对入住 ICU、机械通气需求、抗菌治疗或死亡率没有影响。总之，我们的研究描述了一组大量有症状的免疫功能低下患者中呼吸道病原体的流行病学，并提供了病原体检测与补充氧气需求之间存在关联的证据。在排除流感病毒阳性结果后，这种关联仍然存在，这表明非流感病毒也会导致免疫功能低下患者发生严重的呼吸道疾病。
