Epidemiologic Characteristics and Clinical Significance of Respiratory Viral Infections Among Adult Patients Admitted to the Intensive Care Unit

Jeong Yeon Kim; Kyung Sook Yang; Youseung Chung; Ki-Byung Lee; Jin Woong Suh; Sun Bean Kim; Jang Wook Sohn; Young Kyung Yoon

doi:10.3389/fmed.2022.829624

Epidemiologic Characteristics and Clinical Significance of Respiratory Viral Infections Among Adult Patients Admitted to the Intensive Care Unit

Front Med (Lausanne). 2022 May 24:9:829624. doi: 10.3389/fmed.2022.829624. eCollection 2022.

Authors

Jeong Yeon Kim¹, Kyung Sook Yang², Youseung Chung¹, Ki-Byung Lee¹, Jin Woong Suh¹, Sun Bean Kim¹, Jang Wook Sohn¹, Young Kyung Yoon¹

Affiliations

¹ Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea.
² Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea.

Abstract

Background: The diagnosis of respiratory viral infections (RVIs) in critically ill patients is important for determining treatment options and adhering to infection-control protocols. However, data on the incidence and occurrence patterns of RVIs are scarce. We investigated the epidemiology and clinical impact of RVIs in critically ill patients.

Methods: This retrospective observational study was conducted in a tertiary hospital in South Korea between November 2014 and September 2020. Adult patients (≥ 18 years of age) who tested positive for an RVI by multiplex polymerase chain reaction (mPCR) and were admitted to the intensive care unit (ICU) were included in the study. Clinical characteristics and outcomes were obtained by reviewing electronic medical records. Pearson's χ² test and Fisher's exact test, Mann-Whitney U test was used to compare between groups of patients. Trend analysis and the χ²-based Q test was used to analyze test behavior of physicians performing mPCR test.

Results: Among 22,517 patients admitted to the ICU during the study period, 2,222 (9.9%) underwent mPCR testing for an RVI. The median timing of mPCR testing after ICU admission was 1 day (IQR, 0-2). A total of 335 (15.1%) non-duplicative RVI-positive cases were included in the analysis. The incidence rate of RVIs in ICU patients was 30.45 per 10,000 patient-days. The most frequently detected RVI was influenza A (27.8%), followed by rhinovirus (25.4%). Thirty-two (9.6%) RVI-positive patients were diagnosed with upper respiratory infections, 193 (64.1%) with community-acquired, and 108 (35.9%) with hospital-acquired pneumonia. All-cause mortality and mortality related to respiratory tract infection (RTI) were 30.7% and 22.1%, respectively. The initial presentation of septic shock, requirement for mechanical ventilation, and lymphocytopenia were significant predictors of RTI-related mortality. Of the RVI-positive patients, 151 (45.1%) had nonviral coinfections and presented with higher clinical severity and longer hospital stays than patients infected solely with viral pathogens.

Conclusion: The incidence of RVIs in ICU patients is common. ICU patients with RVIs had high mortality and frequently presented with coinfections with nonviral pathogens, which were associated with a higher clinical severity than sole RVI. Increased testing for RVIs will enhance infection-control efforts and improve patient care.

Keywords: epidemiology; intensive care units; pneumonia; respiratory viral infections; viral diseases.