RESPIRATORY INFECTION

Respiratory viruses in bronchoalveolar lavage: a hospital-based cohort study in adults

J Garbino¹, P M Soccal^2,3, J-D Aubert⁴, T Rochat², P Meylan⁵, Y Thomas⁶, C Tapparel⁶, P-O Bridevaux², L Kaiser⁶

¹ Division of Infectious Diseases, University Hospitals of Geneva, Geneva, Switzerland
² Division of Pulmonary Medicine, University Hospitals of Geneva, Geneva, Switzerland
³ Clinic of Thoracic Surgery, University Hospitals of Geneva, Geneva, Switzerland
⁴ Division of Pulmonary Medicine, University Hospital of Lausanne, Lausanne, Switzerland
⁵ Institute of Microbiology and Division of Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland
⁶ Central Laboratory of Virology, Division of Infectious Diseases, University Hospitals of Geneva, Geneva, Switzerland

Dr J Garbino, Division of Infectious Diseases, University Hospitals of Geneva, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland; jorge.garbino{at}hcuge.ch

Background: The epidemiology of respiratory viruses and their potential clinical impact when recovered in lower respiratory specimens has not been established in the hospital setting. A study was performed to investigate the association between positive viral detection and respiratory infection in an at-risk population.

Methods: 299 adult patients who underwent bronchoalveolar lavage (BAL) procedures were enrolled in a hospital-based prospective cohort study. Descriptive epidemiology is presented of 17 different respiratory viruses detected by reverse transcription-polymerase chain reaction assays in BAL fluid specimens. Multivariate analysis was conducted to identify the clinical characteristics independently associated with the presence of virus.

Results: Of 522 BAL fluid specimens analysed, 81% were collected in adult transplant recipients or other immunocompromised patients. Overall, PCR assays identified viral nucleic acid in 91 BAL fluid samples (17.4%). Similar rates of virus-positive BAL fluid were found in the different subpopulations studied (p = 0.113). Coronaviruses were the most frequent (32.3%), followed by rhinovirus (22.6%), parainfluenza (19.5%), influenza (9.7%), respiratory synctial virus (8.6%), human metapneumovirus (4.2%) and bocavirus (3.1%). Multivariate analysis using mixed models showed that respiratory viral infections were associated with a lack of antibiotic treatment response (OR 2.2, 95% CI 1.2 to 4.1) and the absence of radiological infiltrate (OR 0.3, 95% CI 0.2 to 0.8). In lung transplant recipients in whom a respiratory infection was suspected, the respiratory viral detection rate was 24.4% compared with 13.8% overall in other patients (p = 0.02).

Conclusions: In this cohort of hospitalised adults, respiratory viruses detected in BAL fluid specimens were associated with respiratory symptoms, absence of radiological infiltrates and a poor response to antibiotic therapy.

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