Viral testing should be carried out among all older individuals who have been admitted to hospital for nursing home-acquired pneumonia (NHAP), recommend researchers.
"Early detection of viral pneumonia is very important for hospital infection control, timely use of antiretroviral therapy and discharge planning," say Hon Ming Ma (The Chinese University of Hong Kong, China) and colleagues. "This is particularly relevant for nursing home residents, because they might be hospitalized for isolation to avoid spreading viral infection in nursing homes," they add.
Currently, community-acquired pneumonia (CAP) is generally presumed to be caused by bacterial pathogens, and antibiotics are administered in almost all cases of hospital admissions, explains the team. However, previous studies of CAP in older patients (aged ≥65 years) have shown that in more than half of cases, "pneumonia of unknown etiology" is diagnosed.
In this prospective cohort study of 488 older patients admitted to hospital for CAP, the researchers found infective causes in 137 (28.1%) patients, 34 of whom were nursing home residents and 103 community-living older adults.
As reported in Geriatrics and Gerontology International, sputum culturing and nasopharyngeal aspirate (NPA) testing showed that of the total population, 86 (17.6%) patients had bacterial infections and 41 (8.4%) had viral infections, while mixed infections were detected in 10 (2.0%) patients. Bacterial, viral, and mixed infections were found in 14, 19, and one nursing home resident and in 72, 22, and nine community-living older patients, respectively.
The most common bacteria identified among patients with infective causes were Haemophilus influenzae (n=31), Pseudomonas aeruginosa (n=15), Mycobacterium tuberculosis (n=14), Klebsiella spp (n=9), and Streptococcus pneumoniae (n=6), reports the team. The most common viral infections were influenza A virus, respiratory syncytial virus, and H1N1 (human swine flu) virus, which occurred in 21, 16, and eight individuals, respectively.
Further analysis showed that nursing home residency and absence of leukocytosis were independent predictors for viral pneumonia, at relative risks of 3.06 and 0.43, respectively.
The team suggests that nasopharyngeal aspirate viral testing should be routine for nursing home residents hospitalized for CAP and that "in addition to antibiotic therapy, antiviral agents might be considered as empirical treatment if outbreaks of influenza-like illness are reported in nursing homes."
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