Baron, Adeline

Beduneau, Gaetan

Boyer, Déborah

Carpentier, Dorothée

Girault, Christophe

Giry, Marion

Grange, Steven

Gueudin, Marie

Misset, Benoit,

Skallil, Soumaya

Tamion, Fabienne

English

Archive Ouverte en Sciences de l'Information et de la Communication

HAL Id: hal-02264276
https://hal-normandie-univ.archives-ouvertes.fr/hal-02264276
Submitted on 6 Aug 2019
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Impact of respiratory viruses in intensive care unit
patient with community-acquired pneumonia : a
one-year retrospective single-centre study.
Marion Giry, Marie Gueudin, Déborah Boyer, Adeline Baron, Gaetan
Beduneau, Soumaya Skallil, Steven Grange, Dorothée Carpentier, Fabienne
Tamion, Christophe Girault, et al.
To cite this version:
Marion Giry, Marie Gueudin, Déborah Boyer, Adeline Baron, Gaetan Beduneau, et al.. Impact of
respiratory viruses in intensive care unit patient with community-acquired pneumonia : a one-year
retrospective single-centre study.. ECCMID, Apr 2019, Amsterdam, Netherlands. ￿hal-02264276￿
Impact	  of	  respiratory	  viruses	  in	  intensive	  care	  unit	  pa2ents	  with	  community-­‐acquired	  
pneumonia	  :	  a	  one-­‐year	  retrospec2ve	  single-­‐centre	  study	  	  
Marion	  Giry	  (1),	  Marie	  Gueudin	  (2),	  Déborah	  Boyer	  (1),	  Adeline	  Baron	  (2),	  Gaetan	  Beduneau	  (1),	  Soumaya	  Skallil	  (2),	  Steven	  Grange	  (1),	  	  
Dorothée	  CarpenAer	  (1),	  Fabienne	  Tamion	  (1),	  	  Christophe	  Girault	  (1),	  Benoit	  Misset	  (3)	  
(1)	  Rouen	  University	  Hospital,	  Medical	  ICU,	  F-­‐76000,	  Rouen,	  France	  	  	  	  	  (2)	  Rouen	  University	  Hospital,	  Department	  of	  Microbiology,	  F-­‐76000,	  Rouen,	  France	  	  
(3)	  Liège	  University	  Hospital,	  ICU,	  Liège,	  Belgium	  
	  
	  
Background	  
Pneumonia	  is	  the	  most	  frequent	  community-­‐acquired	  infecAon	  responsible	  for	  Intensive	  
Care	  Unit	   (ICU)	   admission.	   Rapid	  mul2plex	   PCR	  enables	   early	   diagnosis	   of	   respiratory	  
infecAons	  in	  daily	  rouAne	  tesAng.	  Few	  studies	  have	  been	  described	  since	  this	  technique	  
has	  been	  made	  available	  in	  rouAne.	  	  
Methods	  	  
We	  conducted	  a	  retrospec2ve	  analysis	  of	  data	  obtained	  in	  a	  French	  27	  ICU-­‐bed	  medical	  
unit	   admiWng	   around	   1,000	   paAents	   a	   year.	   From	  November	   2016	   to	   October	   2017,	  
naso-­‐pharyngal	  swabs	  from	  223	  paAents	  were	  collected	  within	  72h	  aEer	  admission	  to	  
ICU	   and	   tested	   for	   24	   pathogens	   using	   the	   sample	   to	   answer	   ePlex	   Respiratory	  
Pathogen	   Panel	   which	   delivered	   results	   in	   1.5	   hours	   (mulAplex	   PCR).	   For	   bacteria	  
tesAng,	   we	   used	   standard	   techniques	   (sputum,	   bronchial	   aspiraAon,	   bronchoalveolar	  
lavage	  or	  blood	  culture).	  
Results	  
A	  total	  of	  109	  pa2ents	  had	  CAP,	  39	  had	  aspiraAon	  or	  opportunisAc	  pneumonia,	  22	  non-­‐
pulmonary	   infecAons,	  11	  pulmonary	  edema,	  19	  exacerbaAons	  of	   chronic	   lung	  disease,	  
and	  24	  other	  diagnoses.	  PaAents	  with	  CAP	  had	  the	  following	  characterisAcs:	  age	  60	  +/-­‐	  
16	   years,	   male	   sex	   60%,	   length	   of	   stay	   (LOS)	   in	   ICU	   8.7	   +/-­‐	   9.0	   days,	   mechanical	  
venAlaAon	  45%	  and	  mortality	  11%.	  	  
Conclusion	  
In	   our	   ICU	  populaAon,	   respiratory	   viruses	  were	   present	   in	  40%	  of	   CAP.	   PaAents	  with	  
mixed	   infec2ons	  had	   longer	   ICU-­‐LOS.	   These	   results	   are	   consistent	  with	   other	   studies	  
made	   on	   this	   topic	   (Voriot	   et	   al.,	   Cri-cal	   Care,	   2016).	   More	   studies	   are	   needed	   to	  
evaluate	   if	   the	   implementaAon	   of	   rapid	   diagnosAc	   tesAng	   using	   mulAplex	   PCR	   could	  
reduce	  overuse	  of	  anAbioAcs	  in	  paAents	  with	  CAP.	  	  
The	  SAPS	  2	  score	  was	  higher	  in	  the	  mixed	  group	  (p	  =	  0.02).	  The	  ICU-­‐LOS	  was	  5.6	  (no	  
agent),	  7.7	  (virus),	  10.0	  (bacteria)	  and	  14.8	  (mixed)	  days	  respecAvely	  (p=0.05).	  Mortality	  
was	  9,4%	  (no	  agent),	  7,2%	  (virus),	  15,2%	  (bacteria)	  and	  6,3%	  (mixed)	  with	  no	  staAsAcal	  
diﬀerence.	  
The	  main	  detected	  bacteria	  were	  S.	  pneumonia	  (23%)	  and	  H.	  inﬂuenza	  (6,5%).	  The	  main	  
viruses	  were	  Rhinovirus/Enterovirus	  (14	  %),	  Inﬂuenzae	  A	  (11	  %)	  and	  Parainﬂuenzae	  
virus	  (5%)	  and	  the	  most	  frequent	  virus-­‐bacteria	  associaAons	  were	  S.	  pneumoniae	  with	  
Inﬂuenzae	  A	  (3%)	  and	  S.	  pneumoniae	  with	  Rhinovirus/Enterovirus	  (3%).	  	  
Objec2ves	  
To	   assess	   the	   prevalence	   and	   distribu2on	   of	   pathogens	   among	   ICU	   paAents	   with	  
community-­‐acquired	  pneumonia	  (CAP)	  and	  the	  relaAonship	  with	  severity	  and	  outcome.	  
Figure	   2	   :	   Box-­‐and-­‐Whisker	   plot	   represenAng	   the	  distribuAon	  of	   the	   LOS	  depending	  of	   the	   4	   groups	   of	  
paAents.	  	  
Image	  1:	  ePlex	  Respiratory	  Pathogen	  Panel	  device	  
Figure	  1:	  RaAo	  of	  bacteria	  and	  viruses	  among	  CAP	  
Pathogens	   Pa2ents	  number	  
No	  infec2ous	  agent	   34	  
Virus	  only	   28	  
Bocavirus	   1	  
Coronavirus	   2	  
Inﬂuenza	  A	   6	  
Inﬂuenza	  A	  +	  Rhinovirus/Enterovirus	   1	  
Adenovirus	   2	  
Metapneumovirus	   1	  
Rhinovirus/Enterovirus	   10	  
Parainﬂuenza	   4	  
RSV	  +	  Rhinovirus/Enterovirus	   1	  
Bacteria	  only	   31	  
Citrobacter	  koseri	  +	  S.	  aureus	   1	  
E.	  coli	   2	  
H.	  inﬂuenzae	   4	  
L.	  pneumophila	   2	  
Mycoplasma	  pneumoniae	   1	  
P.	  aeruginosa	   1	  
S.	  aureus	  	   1	  
S.	  haemolyAcus	   1	  
S.	  pneumoniae	  	   13	  
S.	  pneumoniae	  	  +	  E.	  coli	   1	  
S.	  pneumoniae	  +	  H.	  inﬂuenzae	   2	  
Others	  bacteria	   2	  
Virus	  and	  bacteria	   16	  
Inﬂuenza	  A	  +	  P.	  aeruginosa	   1	  
Inﬂuenza	  A	  +	  S.	  aureus	  +	  M.	  catarrhalis	   1	  
Inﬂuenza	  A	  +	  S.	  pneumoniae	  	   2	  
Inﬂuenza	  A	  +	  S.	  pneumoniae	  	  +	  M.	  catarrhalis	   1	  
Inﬂuenza	  A	  +	  Streptococcus	  pyogenes	   1	  	  
Metapneumovirus	  +	  S.	  aureus	  	   1	  
Metapneumovirus	  +	  S.	  pneumoniae	  	   1	  
Rhinovirus/Enterovirus	  +	  H.	  inﬂuenzae	   1	  
Rhinovirus/Enterovirus	  +	  S.	  pneumoniae	  	   3	  
Parainﬂuenza	  +	  H.	  inﬂuenzae	   1	  
Parainﬂuenza	  +	  S.pneumoniae	  	   1	  
RSV	  +	  Adenovirus	  +	  L.	  pneumophila	   1	  
RSV	  +	  S.	  pneumoniae	  	   1	  
Total	   109	  
Table	  1:	  DistribuAon	  of	  pathogens	  among	  CAP	  
	  


Impact of respiratory viruses in intensive care unit patient with community-acquired pneumonia : a one-year retrospective single-centre study.

https://hal-normandie-univ.archives-ouvertes.fr/hal-02264276/file/Poster%20ECCMID%202019%20MG%20-%20PDF%202.pdf

Impact of respiratory viruses in intensive care unit patient with community-acquired pneumonia : a one-year retrospective single-centre study.

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Archive Ouverte en Sciences de l'Information et de la Communication