Please use this identifier to cite or link to this item: https://doi.org/10.1186/s12879-018-3366-4
Title: Impact of microbial Aetiology on mortality in severe community-acquired pneumonia
Authors: Quah, J
Jiang, B
Tan, P.C
Siau, C 
Tan, T.Y 
Keywords: C reactive protein
procalcitonin
calcitonin
adult
aged
APACHE
Article
bacterial infection
cohort analysis
community acquired pneumonia
controlled study
disease association
disease severity
female
groups by age
hospital mortality
human
Influenza A virus
major clinical study
male
microbial identification
microorganism
middle aged
mixed infection
mortality
mortality risk
nonhuman
protein blood level
respiratory virus
retrospective study
Singapore
Streptococcus pneumoniae
survival
virus infection
bacterial pneumonia
blood
community acquired infection
complication
Influenza B virus
intensive care unit
isolation and purification
microbiology
severity of illness index
statistical model
virology
virus pneumonia
Aged
Calcitonin
Community-Acquired Infections
Female
Hospital Mortality
Humans
Influenza B virus
Intensive Care Units
Logistic Models
Male
Middle Aged
Pneumonia, Bacterial
Pneumonia, Viral
Retrospective Studies
Severity of Illness Index
Singapore
Streptococcus pneumoniae
Issue Date: 2018
Citation: Quah, J, Jiang, B, Tan, P.C, Siau, C, Tan, T.Y (2018). Impact of microbial Aetiology on mortality in severe community-acquired pneumonia. BMC Infectious Diseases 18 (1) : 451. ScholarBank@NUS Repository. https://doi.org/10.1186/s12879-018-3366-4
Rights: Attribution 4.0 International
Abstract: Background: The impact of different classes of microbial pathogens on mortality in severe community-acquired pneumonia is not well elucidated. Previous studies have shown significant variation in the incidence of viral, bacterial and mixed infections, with conflicting risk associations for mortality. We aimed to determine the risk association of microbial aetiologies with hospital mortality in severe CAP, utilising a diagnostic strategy incorporating molecular testing. Our primary hypothesis was that respiratory viruses were important causative pathogens in severe CAP and was associated with increased mortality when present with bacterial pathogens in mixed viral-bacterial co-infections. Methods: A retrospective cohort study from January 2014 to July 2015 was conducted in a tertiary hospital medical intensive care unit in eastern Singapore, which has a tropical climate. All patients diagnosed with severe community-acquired pneumonia were included. Results: A total of 117 patients were in the study. Microbial pathogens were identified in 84 (71.8%) patients. Mixed viral-bacterial co-infections occurred in 18 (15.4%) of patients. Isolated viral infections were present in 32 patients (27.4%); isolated bacterial infections were detected in 34 patients (29.1%). Hospital mortality occurred in 16 (13.7%) patients. The most common bacteria isolated was Streptococcus pneumoniae and the most common virus isolated was Influenza A. Univariate and multivariate logistic regression showed that serum procalcitonin, APACHE II severity score and mixed viral-bacterial infection were associated with increased risk of hospital mortality. Mixed viral-bacterial co-infections were associated with an adjusted odds ratio of 13.99 (95% CI 1.30-151.05, p = 0.03) for hospital mortality. Conclusions: Respiratory viruses are common organisms isolated in severe community-acquired pneumonia. Mixed viral-bacterial infections may be associated with an increased risk of mortality. © 2018 The Author(s).
Source Title: BMC Infectious Diseases
URI: https://scholarbank.nus.edu.sg/handle/10635/181181
ISSN: 14712334
DOI: 10.1186/s12879-018-3366-4
Rights: Attribution 4.0 International
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