Virus infection in exacerbations of chronic obstructive pulmonary disease
requiring ventilation |
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Authors: | Robert J Cameron Deo de Wit Toni N Welsh John Ferguson Terry V Grissell Peter J Rye |
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Institution: | (1) ICU, Gosford Hospital, PO Box 361, NSW 2250 Gosford, Australia;(2) Director of Microbiology, Gosford Hospital, PO Box 361, NSW 2250 Gosford, Australia;(3) Hunter Area Pathology Service, John Hunter Hospital, Newcastle, NSW 2310, Australia;(4) Hunter Medical Research Institute, University of Newcastle, NSW 2310 Newcastle, Australia |
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Abstract: | Objectives We aimed to characterise and quantify the incidence of
common infectious agents in acute exacerbations of chronic obstructive
pulmonary disease (COPD) requiring ventilation, with a focus on respiratory
viruses.Design An epidemiological study conducted over 3 years.Setting A 12-bed intensive care unit (ICU).Participants ICU patients over 45 years of age with a primary
diagnosis of COPD exacerbation requiring non-invasive ventilation (NIV) or
ventilation via endotracheal tube (ETT).Materials and methods Nasopharyngeal aspirates (NPA) and posterior
pharyngeal swabs (PS) were tested for viruses with immunofluorescence assay
(IFA), virus culture (VC) and polymerase chain reaction (PCR). Paired virus
and atypical pneumonia serology assays were taken. Blood, sputum and
endotracheal aspirates were cultured for bacteria.Results 107 episodes in 105 patients were recorded. Twenty-three
(21%) died within 28 days. A probable infectious aetiology was found in
69 patient episodes (64%). A virus was identified in 46 cases (43%),
being the sole organism in 35 cases (33%) and part of a mixed infection
in 11 cases (10%). A probable bacterial aetiology was found in 25 cases
(23%). There was no statistically significant difference in clinical
characteristics or outcomes between the group with virus infections and that
without.Conclusion Forty-six (43%) of the patients with COPD
exacerbation requiring mechanical ventilation had a probable viral pathogen.
Prodromal, clinical and outcome parameters did not distinguish virus from
non-virus illness. PCR was the most sensitive whilst virus culture was the
least of virus assays.Electronic supplementary material The electronic reference of this article is . The online full-text version of this article includes electronic supplementary material. This material is available to authorised users and can be accessed by means of the ESM button beneath the abstract or in the structured full-text article. To cite or link to this article you can use the above reference.The study was self-funded by internal grants from the Central Coast Health
Services Research Fund and the Hunter Area Pathology Service. There was no
funding from pharmaceutical or other commercial organisations or agencies.There was no conflict of interest.This article is discussed in the editorial available at: |
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Keywords: | COPD exacerbation Ventilation Infection Virus |
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