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Respiratory viral infections are underdiagnosed in patients with suspected sepsis

Journal article
Authors Lars R. Ljungström
Gunnar Jacobsson
B. E. B. Claesson
R. Andersson
H. Enroth
Published in European Journal of Clinical Microbiology & Infectious Diseases
Volume 36
Issue 10
Pages 1767-1776
ISSN 0934-9723
Publication year 2017
Published at Centre for antibiotic resistance research, CARe
Institute of Biomedicine, Department of Infectious Medicine
Pages 1767-1776
Language en
Links 10.1007/s10096-017-2990-z
Keywords community-acquired pneumonia, tract-infections, streptococcus-pneumoniae, bacterial pneumonia, influenza-virus, septic, shock, assay, pcr, coinfection, diagnosis
Subject categories Microbiology in the medical area

Abstract

The study aim was to investigate the prevalence and clinical relevance of viral findings by multiplex PCR from the nasopharynx of clinically septic patients during a winter season. During 11 weeks of the influenza epidemic period in January-March 2012, consecutive adult patients suspected to be septic (n = 432) were analyzed with cultures from blood and nasopharynx plus multiplex PCR for respiratory viruses on the nasopharyngeal specimen. The results were compared with those from microbiology analyses ordered as part of standard care. During the winter season, viral respiratory pathogens, mainly influenza A virus, human metapneumovirus, coronavirus, and respiratory syncytial virus were clinically underdiagnosed in 70% of patients positive by the multiplex PCR assay. During the first four weeks of the influenza epidemic, few tests for influenza were ordered by clinicians, indicating low awareness that the epidemic had started. Nasopharyngeal findings of Streptococcus pneumoniae and Haemophilus influenzae by culture correlated to pneumonia diagnosis, and in those patients laboratory signs of viral co-infections were common but rarely suspected by clinicians. The role of respiratory viral infections in patients presenting with a clinical picture of sepsis is underestimated. Specific antiviral treatment might be beneficial in some cases and may reduce spread in a hospital setting. Diagnosing viral infections may promote reduction of unnecessary antibiotic use. It can also be a tool for decisions concerning patient logistics, in order to minimize exposure of susceptible patients and personnel.

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