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Respiratory infection
Respiratory viruses in bronchoalveolar lavage: a hospital-based cohort study in adults
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  1. J Garbino1,
  2. P M Soccal2,3,
  3. J-D Aubert4,
  4. T Rochat2,
  5. P Meylan5,
  6. Y Thomas6,
  7. C Tapparel6,
  8. P-O Bridevaux2,
  9. L Kaiser6
  1. 1
    Division of Infectious Diseases, University Hospitals of Geneva, Geneva, Switzerland
  2. 2
    Division of Pulmonary Medicine, University Hospitals of Geneva, Geneva, Switzerland
  3. 3
    Clinic of Thoracic Surgery, University Hospitals of Geneva, Geneva, Switzerland
  4. 4
    Division of Pulmonary Medicine, University Hospital of Lausanne, Lausanne, Switzerland
  5. 5
    Institute of Microbiology and Division of Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland
  6. 6
    Central Laboratory of Virology, Division of Infectious Diseases, University Hospitals of Geneva, Geneva, Switzerland
  1. 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

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. 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.

https://doi.org/10.1136/thx.2008.105155

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    Footnotes

    • Funding: This study was supported by a grant of the Swiss National Foundation to Laurent Kaiser (3200B-101670).

    • Competing interests: None.

    • Ethics approval: Ethical approval for this study was obtained from the ethics committees of the University Hospitals of Geneva and the University Hospital of Lausanne and signed informed consent was obtained from all patients.

    • PMS and J-DA contributed equally to the study.

      JG participated in the development of the study design, implemented the study, and was in charge of data management and analysis and the writing and revision of the manuscript. PMS assisted in the study design, supervised the study in Geneva, collected data and participated in the analysis and writing of the manuscript. J-DA assisted in the study design, supervised the study in Lausanne, collected data, participated in the analysis of the data and the writing of the manuscript. TR participated in the study design, helped to oversee the implementation, supported the recruitment of the patients and assisted with manuscript preparation. PM helped to process the samples and to implement the study in Lausanne and assisted with manuscript preparation. YT was in charge of the development of the molecular assays used, supervised the laboratory analysis and assisted with manuscript preparation. CT was in charge of the development of the molecular assays used, supervised the laboratory analysis and assisted with manuscript preparation. POB was in charge of the data management, analysis and the statistical methods, and participated actively in the writing and revision of the manuscript. LK (guarantor) had the initial idea for the study, designed the protocol, supervised the laboratory analysis and was the recipient of the funding. He participated in the data analysis, wrote the manuscript and revised article drafts for publication. LK takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors have seen and approved the final version.