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Respiratory viruses in bronchoalveolar lavage: a hospital-based cohort study in adults
  1. Jorge Garbino (jorge.garbino{at}hcuge.ch)
  1. University Hospitals of Geneva, Switzerland
    1. Paola M Soccal
    1. University Hospitals of Geneva, Switzerland
      1. John-David Aubert
      1. University Hospitals of Geneva, Switzerland
        1. Thierry Rochat
        1. University Hospital of Lausanne, Switzerland
          1. Pascal Meylan
          1. University Hospitals of Geneva, Switzerland
            1. Yves Thomas
            1. University Hospital of Lausanne, Switzerland
              1. Caroline Tapparel
              1. University Hospitals of Geneva, Switzerland
                1. Pierre-Olivier Bridevaux
                1. University Hospitals of Geneva, Switzerland
                  1. Laurent Kaiser
                  1. University Hospitals of Geneva, Switzerland

                    Abstract

                    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.

                    Objective: To investigate the association between positive viral detection and respiratory infection in an at-risk population.

                    Design: Prospective cohort study.

                    Setting: Hospital-based.

                    Patients: 299 adult patients who underwent bronchoalveolar lavage (BAL) procedures.

                    Measurements: Descriptive epidemiology of 17 different respiratory viruses detected by reverse transcription-polymerase chain reaction (PCR) assays in BAL specimens. Multivariate analysis was conducted to identify the clinical characteristics independently associated with the presence of virus.

                    Results: Of 522 BAL specimens analysed, 81% were collected in adult transplant recipients or other immunocompromised patients. Overall, PCR assays identified viral nucleic acid in 91 (17.4%) BAL samples. Similar rates of virus-positive BAL 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 1.2–4.1) and the absence of radiological infiltrate (OR 0.3, 95% CI 0.2–0.8). In lung transplant recipients in whom a respiratory infection was suspected, the respiratory viral detection rate was 24.4% compared to 13.8% overall in other patients (p=0.02).

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

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