Human metapneumovirus as cause of severe community-acquired pneumonia in adults : insights from a ten-year molecular and epidemiological analysis
Vidaur, Loreto (Hospital Universitario de Donostia (Sant Sebastià, País Basc))
Totorika, Izarne (Hospital Universitario de Donostia (Sant Sebastià, País Basc))
Montes, Milagrosa (Hospital Universitario de Donostia (Sant Sebastià, País Basc))
Vicente, Diego (University of Basque Country)
Rello, Jordi (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Cilla, Gustavo (Hospital Universitario de Donostia (Sant Sebastià, País Basc))
Universitat Autònoma de Barcelona

Fecha:	2019
Resumen:	Background: 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. Methods: 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. Results: 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. Conclusion: 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.
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Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Severe community-acquired pneumonia ; Human metapneumovirus ; Acute respiratory distress syndrome ; Biomarkers
Publicado en:	Annals of Intensive Care, Vol. 9 (july 2019) , ISSN 2110-5820

DOI: 10.1186/s13613-019-0559-y
PMID: 31342206

6 p, 797.1 KB

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