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2013 ; 13
(4
): 949-57
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Predictors of viral pneumonia: the need for viral testing in all patients
hospitalized for nursing home-acquired pneumonia
#MMPMID23441872
Ma HM
; Lee KP
; Woo J
Geriatr Gerontol Int
2013[Oct]; 13
(4
): 949-57
PMID23441872
show ga
AIM: Community-acquired pneumonia (CAP) is presumed to be bacterial in origin and
empirical antibiotics are almost always given on admission. However, early
detection of viral infection is also very important for hospital infection
control and timely use of antiviral agents. The present study aimed to compare
patients with viral and bacterial pneumonia, and identify independent predictors
of viral pneumonia. METHODS: A prospective cohort study was carried out in a
tertiary teaching hospital in a 1-year period. Older patients (aged ? 65 years)
were recruited if they were admitted for CAP confirmed by chest radiographs.
RESULTS: A cohort of 488 patients was analyzed. Infective causes were found in
137 (28.1%) patients. Bacterial, viral and mixed infections were detected in 86
(17.6%), 41 (8.4%) and 10 (2.0%) patients, respectively. Bacteriology was
established mostly by sputum culture and virology by nasopharyngeal aspirate
(NPA) viral culture. The commonest bacterial isolates were Haemophilus influenzae
(31), Pseudomonas aeruginosa (15), Mycobacterium tuberculosis (14), Klebsiella
spp. (9) and Streptococcus pneumoniae (6). Influenza A virus (28, 8 were pandemic
2009 A/H1N1 subtype) and respiratory syncytial virus (16) were the most frequent
viral causes. Independent predictors of viral pneumonia included nursing home
residence (RR 3.056, P = 0.009) and absence of leukocytosis (RR 0.425, P =
0.026). CONCLUSIONS: All nursing home residents hospitalized for CAP should
undergo NPA viral testing because of infection control, early antiviral treatment
and discharge planning. We suggest that empirical antiviral agents might be
considered for nursing home residents hospitalized for CAP if outbreaks of
influenza-like illness are reported in nursing homes.