Methods: Adults hospitalized with acute respiratory illness (ARI) were prospectively enrolled from two Michigan hospitals during the 2014-2015 influenza season. CAP cases were defined by ICD-9 codes (480-487.0). Patients were characterized by demographics, self-reported frailty, Charlson Comorbidity Index (CCI) score, influenza and pneumococcal vaccination, and clinical outcomes. Respiratory specimens were tested for influenza and respiratory syncytial virus (RSV) by RT-PCR. Clinical multiplex RT-PCR testing for other respiratory pathogens were available for a subset of enrollees.
Results: 224 (36%) of 624 adults hospitalized with ARI had ICD-9 codes consistent with CAP. These patients were older (p < 0.001), had higher CCI scores (p = 0.002), and had more immunosuppressive disorders (p=0.005) and malignancies (p=0.02) than those without CAP. Patients with CAP were less likely to be frail (p = 0.046) or morbidly obese (p=0.01). CAP patients were more likely to have received influenza vaccine (p=0.003), but not pneumococcal vaccine. CAP patients had longer hospitalizations, (mean difference 0.5 days, p < 0.001) and were more likely discharged to another facility (OR 2.2 95%CI 1.2-4.3). Influenza A(H3N2) was more frequently detected in non-CAP patients (19%) than those with CAP (10%). The frequency of RSV infection was similar for both groups (9% and 8%). Those with CAP were more likely to be tested clinically than those without (OR 2.0 95%CI 1.3-3.2). Human Metapneumovirus (hMPV), rhinovirus (HRV), and parainfluenza viruses (PIV) were similarly frequent in CAP patients who underwent clinical testing: 7/110 (6.4%), 8/110 (7.3%), and 8/110 (7.3%) respectively; all were detected more frequently in CAP patients, but differences were not statistically significant.
Conclusion: Patients with CAP were less healthy and had more severe clinical outcomes than non-CAP patients. Among those with CAP, influenza was the most commonly identified viral pathogen, with RSV, HRV, hMPV and PIV also associated with a substantial number of cases.
R. E. Malosh,
E. T. Martin, None
J. M. Ferdinands, None
A. M. Fry, None
A. S. Monto, Sanofi Pasteur: Consultant and Grant Investigator , Consulting fee and Grant recipient
GSK: Consultant , Consulting fee
Novavax: Consultant , Consulting fee
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