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.