Tuberc Respir Dis.  2017 Oct;80(4):358-367. 10.4046/trd.2017.0044.

Elucidation of Bacterial Pneumonia-Causing Pathogens in Patients with Respiratory Viral Infection

• Jung HS
• Kang BJ
• Ra SW
• Seo KW
• Jegal Y
• Jun JB
• Jung J
• Jeong J
• Jeon HJ
• Ahn JS
• Lee T
• Ahn JJ

• KMID: 2420578
• DOI: http://doi.org/10.4046/trd.2017.0044

Abstract

BACKGROUND
Bacterial pneumonia occurring after respiratory viral infection is common. However, the predominant bacterial species causing pneumonia secondary to respiratory viral infections other than influenza remain unknown. The purpose of this study was to know whether the pathogens causing post-viral bacterial pneumonia vary according to the type of respiratory virus.
METHODS
Study subjects were 5,298 patients, who underwent multiplex real-time polymerase chain reaction for simultaneous detection of respiratory viruses, among who visited the emergency department or outpatient clinic with respiratory symptoms at Ulsan University Hospital between April 2013 and March 2016. The patients' medical records were retrospectively reviewed.
RESULTS
A total of 251 clinically significant bacteria were identified in 233 patients with post-viral bacterial pneumonia. Mycoplasma pneumoniae was the most frequent bacterium in patients aged <16 years, regardless of the preceding virus type (p=0.630). In patients aged ≥16 years, the isolated bacteria varied according to the preceding virus type. The major results were as follows (p<0.001): pneumonia in patients with influenza virus (type A/B), rhinovirus, and human metapneumovirus infections was caused by similar bacteria, and the findings indicated that Staphylococcus aureus pneumonia was very common in these patients. In contrast, coronavirus, parainfluenza virus, and respiratory syncytial virus infections were associated with pneumonia caused by gram-negative bacteria.
CONCLUSION
The pathogens causing post-viral bacterial pneumonia vary according to the type of preceding respiratory virus. This information could help in selecting empirical antibiotics in patients with post-viral pneumonia.

Keyword

Viruses; Influenza; Pneumonia

MeSH Terms

Ambulatory Care Facilities
Anti-Bacterial Agents
Bacteria
Coronavirus
Emergency Service, Hospital
Gram-Negative Bacteria
Humans
Influenza, Human
Medical Records
Metapneumovirus
Mycoplasma pneumoniae
Orthomyxoviridae
Paramyxoviridae Infections
Pneumonia
Pneumonia, Bacterial
Pneumonia, Mycoplasma
Pneumonia, Staphylococcal
Real-Time Polymerase Chain Reaction
Respiratory Syncytial Virus Infections
Retrospective Studies
Rhinovirus
Ulsan
Anti-Bacterial Agents

Figure

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  Figure 1 Study flowchart. PCR: polymerase chain reaction; CT: computed tomography.

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  Figure 2 Incidence of respiratory viral infection in the study population between April 2013 and March 2016 (p<0.001). hMPV: human metapneumovirus; RSV: respiratory syncytial virus.

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  Figure 3 Age-specific distribution of respiratory viruses. (A) All viruses. (B) Each virus.

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  Figure 4 Seasonal distribution of respiratory viruses between April 2013 and March 2016 (spring: March–May, summer: June–August, fall: September–November, winter: December–February).

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  Figure 5 Incidence of pneumonia (p<0.001) and bacterial pneumonia (p<0.001) associated with respiratory viral infection. RSV: respiratory syncytial virus; CT: computed tomography.

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