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Severity of disease and mortality for hospitalized patients with community-acquired viral pneumonia compared to patients with community-acquired bacterial pneumonia

Background: There exists a large body of literature to help identify, diagnose, treat, and manage community-acquired pneumonia (CAP). Despite this, there is little data that directly compares the clinical syndromes and complications of pure bacterial pneumonia to pure viral pneumonia. Our study compares the clinical presentation, morbidity and mortality of viral vs. bacterial etiologies of CAP. Methods: This was a secondary data analysis of the Community-Acquired Pneumonia Organization (CAPO) international study database. Data was collected concerning patient demographics, physical examination findings, laboratory findings, radiological findings, severity of illness, and clinical outcomes and stratified according to the two study groups, CAVP and CABP. A microbiological diagnosis of CABP was based on the isolation of a bacterium from a respiratory sample, blood culture and/or identification of a urinary antigen for Streptococcus or Legionella; microbiological diagnosis of CAVP was based on polymerase chain reaction or antigen detection from respiratory samples. Results: Our study included 1,913 patients. Of these, 286 (15.0%) had viral infection, while 1,627 (85.0%) had CAVP. We found that bacterial CAP patients are older, more frequently male, and suffer from a higher proportion of comorbidities when compared to viral CAP patients. Comparison of physical exam findings and laboratory values failed to find a clinically significant difference between bacterial and viral CAP patients. When comparing severity of illness, bacterial CAP patients had greater frequency of PSI ≥ class IV; however, viral CAP patients more frequently needed ICU admission, ventilator support, vasopressor support, and had higher rate of in hospital mortality. Conclusions: Our study confirms the extreme difficulty differentiating CABP from CAVP using demographics, physical exam, or x-ray findings. We found no major clinical or laboratory findings distinguishing CABP from CAVP. The increased severity of illness of CAVP compared to bacterial etiologies shows that PSI scores may not be an accurate indicator of severity of disease. More studies are needed to identify the best process of care for patients with CAP, including the potential benefits of routine respiratory viral panel testing and empiric antiviral therapy. DOI: 10.18297/jri/vol3/iss1/3 Received Date: October 26, 2018 Accepted Date: December 18, 2018 https://ir.library.louisville.edu/jri/vol3/iss1/ Affiliations: 1Division of Pulmonary, Critical Care and Sleep Disorders, University of Louisville 2Division of Infectious Diseases, University of Louisville 3Saint Louis University Center for Health Outcomes Research (SLUCOR) This original article is brought to you for free and open access by ThinkIR: The University of Louisville’s Institutional Repository. It has been accepted for inclusion in The University of Louisville Journal of Respiratory Infections by an authorized editor of ThinkIR. For more information, please contact thinkir@louisville. Recommended Citation: Kim, Richard Y.; Chandler, Thomas; Furmanek, Stephen P.; Wiemken, Timothy Lee; and Cavallazzi, Rodrigo (2019) “Severity of disease and mortality for hospitalized patients with community-acquired viral pneumonia compared to patients with community-acquired bacterial pneumonia,” The University of Louisville Journal of Respiratory Infections: Vol. 3 : Iss. 1, Article 3. *Correspondence To: Richard Y Kim, MD Work Address: 401 E Chestnut Street, Suite 310 Louisville, KY, United States, 40202 Work Email: richard.kim@louisville.edu ORIGINAL RESEARCH Copyright: © 2019 The author(s). This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.