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Outcomes of respiratory viral-bacterial co-infection in adult hospitalized patients

BACKGROUND: Viral infections of the respiratory tract represent a major global health concern. Co-infection with bacteria may contribute to severe disease and increased mortality in patients. Nevertheless, viral-bacterial co-infection patterns and their clinical outcomes have not been well character...

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Autores principales: Liu, Yingzhi, Ling, Lowell, Wong, Sunny H, Wang, Maggie HT, Fitzgerald, J.Ross, Zou, Xuan, Fang, Shisong, Liu, Xiaodong, Wang, Xiansong, Hu, Wei, Chan, Hung, Wang, Yan, Huang, Dan, Li, Qing, Wong, Wai T, Choi, Gordon, Zou, Huachun, Hui, David SC, Yu, Jun, Tse, Gary, Gin, Tony, Wu, William KK, Chan, Matthew TV, Zhang, Lin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8343259/
https://www.ncbi.nlm.nih.gov/pubmed/34386745
http://dx.doi.org/10.1016/j.eclinm.2021.100955
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author Liu, Yingzhi
Ling, Lowell
Wong, Sunny H
Wang, Maggie HT
Fitzgerald, J.Ross
Zou, Xuan
Fang, Shisong
Liu, Xiaodong
Wang, Xiansong
Hu, Wei
Chan, Hung
Wang, Yan
Huang, Dan
Li, Qing
Wong, Wai T
Choi, Gordon
Zou, Huachun
Hui, David SC
Yu, Jun
Tse, Gary
Gin, Tony
Wu, William KK
Chan, Matthew TV
Zhang, Lin
author_facet Liu, Yingzhi
Ling, Lowell
Wong, Sunny H
Wang, Maggie HT
Fitzgerald, J.Ross
Zou, Xuan
Fang, Shisong
Liu, Xiaodong
Wang, Xiansong
Hu, Wei
Chan, Hung
Wang, Yan
Huang, Dan
Li, Qing
Wong, Wai T
Choi, Gordon
Zou, Huachun
Hui, David SC
Yu, Jun
Tse, Gary
Gin, Tony
Wu, William KK
Chan, Matthew TV
Zhang, Lin
author_sort Liu, Yingzhi
collection PubMed
description BACKGROUND: Viral infections of the respiratory tract represent a major global health concern. Co-infection with bacteria may contribute to severe disease and increased mortality in patients. Nevertheless, viral-bacterial co-infection patterns and their clinical outcomes have not been well characterized to date. This study aimed to evaluate the clinical features and outcomes of patients with viral-bacterial respiratory tract co-infections. METHODS: We included 19,361 patients with respiratory infection due to respiratory viruses [influenza A and B, respiratory syncytial virus (RSV), parainfluenza] and/or bacteria in four tertiary hospitals in Hong Kong from 2013 to 2017 using a large territory-wide healthcare database. All microbiological tests were conducted within 48 h of hospital admission. Four etiological groups were included: (1) viral infection alone; (2) bacterial infection alone; (3) laboratory-confirmed viral-bacterial co-infection and (4) clinically suspected viral-bacterial co-infection who were tested positive for respiratory virus and negative for bacteria but had received at least four days of antibiotics. Clinical features and outcomes were recorded for laboratory-confirmed viral-bacterial co-infection patients compared to other three groups as control. The primary outcome was 30-day mortality. Secondary outcomes were intensive care unit (ICU) admission and length of hospital stay. Propensity score matching estimated by binary logistic regression was used to adjust for the potential bias that may affect the association between outcomes and covariates. FINDINGS: Among 15,906 patients with respiratory viral infection, there were 8451 (53.1%) clinically suspected and 1,087 (6.8%) laboratory-confirmed viral-bacterial co-infection. Among all the bacterial species, Haemophilus influenzae (226/1,087, 20.8%), Pseudomonas aeruginosa (180/1087, 16.6%) and Streptococcus pneumoniae (123/1087, 11.3%) were the three most common bacterial pathogens in the laboratory-confirmed co-infection group. Respiratory viruses co-infected with non-pneumococcal streptococci or methicillin-resistant Staphylococcus aureus was associated with the highest death rate [9/30 (30%) and 13/48 (27.1%), respectively] in this cohort. Compared with other infection groups, patients with laboratory-confirmed co-infection had higher ICU admission rate (p < 0.001) and mortality rate at 30 days (p = 0.028), and these results persisted after adjustment for potential confounders using propensity score matching. Furthermore, patients with laboratory-confirmed co-infection had significantly higher mortality compared to patients with bacterial infection alone. INTERPRETATION: In our cohort, bacterial co-infection is common in hospitalized patients with viral respiratory tract infection and is associated with higher ICU admission rate and mortality. Therefore, active surveillance for bacterial co-infection and early antibiotic treatment may be required to improve outcomes in patients with respiratory viral infection.
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spelling pubmed-83432592021-08-11 Outcomes of respiratory viral-bacterial co-infection in adult hospitalized patients Liu, Yingzhi Ling, Lowell Wong, Sunny H Wang, Maggie HT Fitzgerald, J.Ross Zou, Xuan Fang, Shisong Liu, Xiaodong Wang, Xiansong Hu, Wei Chan, Hung Wang, Yan Huang, Dan Li, Qing Wong, Wai T Choi, Gordon Zou, Huachun Hui, David SC Yu, Jun Tse, Gary Gin, Tony Wu, William KK Chan, Matthew TV Zhang, Lin EClinicalMedicine Research Paper BACKGROUND: Viral infections of the respiratory tract represent a major global health concern. Co-infection with bacteria may contribute to severe disease and increased mortality in patients. Nevertheless, viral-bacterial co-infection patterns and their clinical outcomes have not been well characterized to date. This study aimed to evaluate the clinical features and outcomes of patients with viral-bacterial respiratory tract co-infections. METHODS: We included 19,361 patients with respiratory infection due to respiratory viruses [influenza A and B, respiratory syncytial virus (RSV), parainfluenza] and/or bacteria in four tertiary hospitals in Hong Kong from 2013 to 2017 using a large territory-wide healthcare database. All microbiological tests were conducted within 48 h of hospital admission. Four etiological groups were included: (1) viral infection alone; (2) bacterial infection alone; (3) laboratory-confirmed viral-bacterial co-infection and (4) clinically suspected viral-bacterial co-infection who were tested positive for respiratory virus and negative for bacteria but had received at least four days of antibiotics. Clinical features and outcomes were recorded for laboratory-confirmed viral-bacterial co-infection patients compared to other three groups as control. The primary outcome was 30-day mortality. Secondary outcomes were intensive care unit (ICU) admission and length of hospital stay. Propensity score matching estimated by binary logistic regression was used to adjust for the potential bias that may affect the association between outcomes and covariates. FINDINGS: Among 15,906 patients with respiratory viral infection, there were 8451 (53.1%) clinically suspected and 1,087 (6.8%) laboratory-confirmed viral-bacterial co-infection. Among all the bacterial species, Haemophilus influenzae (226/1,087, 20.8%), Pseudomonas aeruginosa (180/1087, 16.6%) and Streptococcus pneumoniae (123/1087, 11.3%) were the three most common bacterial pathogens in the laboratory-confirmed co-infection group. Respiratory viruses co-infected with non-pneumococcal streptococci or methicillin-resistant Staphylococcus aureus was associated with the highest death rate [9/30 (30%) and 13/48 (27.1%), respectively] in this cohort. Compared with other infection groups, patients with laboratory-confirmed co-infection had higher ICU admission rate (p < 0.001) and mortality rate at 30 days (p = 0.028), and these results persisted after adjustment for potential confounders using propensity score matching. Furthermore, patients with laboratory-confirmed co-infection had significantly higher mortality compared to patients with bacterial infection alone. INTERPRETATION: In our cohort, bacterial co-infection is common in hospitalized patients with viral respiratory tract infection and is associated with higher ICU admission rate and mortality. Therefore, active surveillance for bacterial co-infection and early antibiotic treatment may be required to improve outcomes in patients with respiratory viral infection. Elsevier 2021-06-10 /pmc/articles/PMC8343259/ /pubmed/34386745 http://dx.doi.org/10.1016/j.eclinm.2021.100955 Text en © 2021 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Research Paper
Liu, Yingzhi
Ling, Lowell
Wong, Sunny H
Wang, Maggie HT
Fitzgerald, J.Ross
Zou, Xuan
Fang, Shisong
Liu, Xiaodong
Wang, Xiansong
Hu, Wei
Chan, Hung
Wang, Yan
Huang, Dan
Li, Qing
Wong, Wai T
Choi, Gordon
Zou, Huachun
Hui, David SC
Yu, Jun
Tse, Gary
Gin, Tony
Wu, William KK
Chan, Matthew TV
Zhang, Lin
Outcomes of respiratory viral-bacterial co-infection in adult hospitalized patients
title Outcomes of respiratory viral-bacterial co-infection in adult hospitalized patients
title_full Outcomes of respiratory viral-bacterial co-infection in adult hospitalized patients
title_fullStr Outcomes of respiratory viral-bacterial co-infection in adult hospitalized patients
title_full_unstemmed Outcomes of respiratory viral-bacterial co-infection in adult hospitalized patients
title_short Outcomes of respiratory viral-bacterial co-infection in adult hospitalized patients
title_sort outcomes of respiratory viral-bacterial co-infection in adult hospitalized patients
topic Research Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8343259/
https://www.ncbi.nlm.nih.gov/pubmed/34386745
http://dx.doi.org/10.1016/j.eclinm.2021.100955
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