Vidaur Loreto, Totorika Izarne, Montes Milagrosa, Vicente Diego, Rello Jordi, Cilla Gustavo
Critical Care Department, Donostia University Hospital-Biodonostia Health Research Institute, San Sebastian, Guipuzcoa, Spain.
CIBERES, Institute of Health Carlos III, Madrid, Spain.
Ann Intensive Care. 2019 Jul 24;9(1):86. doi: 10.1186/s13613-019-0559-y.
Information on the clinical, epidemiological and molecular characterization of human metapneumovirus in critically ill adult patients with severe community-acquired pneumonia (CAP) and the role of biomarkers identifying bacterial coinfection is scarce.
This is a retrospective epidemiological study of adult patients with hMPV severe CAP admitted to ICU during a ten-year period with admission PSI score ≥ 3.
The 92.8% of the 28 patients with severe CAP due to human metapneumovirus were detected during the first half of the year. Median age was 62 years and 60.7% were male. The genotyping of isolated human metapneumovirus showed group B predominance (60.7%). All patients had acute respiratory failure. Median APACHE II and SOFA score were 13 and 6.55, respectively. The 25% were coinfected with Streptococcus pneumoniae. 60.7% of the patients had shock at admission and 50% underwent mechanical ventilation. Seven patients developed ARDS, three of them younger than 60 years and without comorbidities. Mortality in ICU was 14.3%. Among survivors, ICU and hospital stay were 6.5 and 14 days, respectively. Plasma levels of procalcitonin were higher in patients with bacterial coinfection (18.2 vs 0.54; p < 0.05). The levels of C-reactive protein, however, were similar.
Human metapneumovirus was associated with severe CAP requiring ICU admission among elderly patients or patients with comorbidities, but also in healthy young subjects. These patients often underwent mechanical ventilation with elevated health resource consumption. While one out of four patients showed pneumococcal coinfection, plasma procalcitonin helped to implement antimicrobial stewardship.
关于重症社区获得性肺炎（CAP）成年危重症患者人偏肺病毒的临床、流行病学及分子特征，以及识别细菌合并感染的生物标志物的作用，相关信息较少。
这是一项回顾性流行病学研究，研究对象为10年间入住重症监护病房（ICU）、入院肺炎严重指数（PSI）评分≥3的成人hMPV重症CAP患者。
28例因人偏肺病毒导致重症CAP的患者中，92.8%是在上半年被检测出的。中位年龄为62岁，男性占60.7%。分离出的人偏肺病毒基因分型显示B组占优势（60.7%）。所有患者均有急性呼吸衰竭。APACHE II评分和序贯器官衰竭评估（SOFA）评分的中位数分别为13分和6.55分。25%的患者合并肺炎链球菌感染。60.7%的患者入院时出现休克，50%的患者接受了机械通气。7例患者发生急性呼吸窘迫综合征（ARDS），其中3例年龄小于60岁且无合并症。ICU死亡率为14.3%。存活患者的ICU住院时间和住院时间分别为6.5天和14天。合并细菌感染的患者降钙素原血浆水平较高（18.2对0.54；p<0.05）。然而，C反应蛋白水平相似。
人偏肺病毒与老年患者或合并症患者以及健康年轻受试者中需要入住ICU的重症CAP相关。这些患者常接受机械通气，卫生资源消耗增加。四分之一的患者合并肺炎球菌感染，血浆降钙素原有助于实施抗菌药物管理。
