Figures
- FIGURE 1
Flow diagram of our literature search for studies. COPD: chronic obstructive pulmonary disease.
- FIGURE 2
Forest plot displaying meta-analysis of the proportion of viral infection in patients with community-acquired pneumonia. Weights are from random-effects analysis.
- FIGURE 3
Forest plot displaying the odds ratio (OR) of death in the presence of viral infection in patients with community-acquired pneumonia. Weights are from random-effects analysis.
Tables
- TABLE 1
Characteristics of the studies
First author [ref.] Study setting Study design Patient population Patients n Viral tests Age years Male % Aims Mortality % Angeles Marcos [3] Spain, 2003–2004, inpatient Prospective cohort Patients aged >14 years admitted to the hospital with CAP 198 PCR, IFA, culture, serology 70 (median) 58 Incidence and characteristics of viral CAP, and yield of tests for viral infection 2.5 van Gageldonk-Lafeber [5] The Netherlands, 2007–2010, inpatient Prospective cohort Patients aged >18 years with CAP in the ED 339 PCR 66 (median) 62.5 Aetiology of CAP Not reported Hara [6] Thailand, 2006–2008, inpatient Prospective cohort Patients aged >16 years admitted to the hospital with CAP 119 PCR 55 (mean) 71.4 Aetiology of CAP 18.5 Holm [22] Denmark, 2002–2003, inpatient and outpatient Prospective cohort Patients aged >18 years with suspected CAP seen in outpatient clinic 48 PCR 50 (median) 49 Aetiology of CAP and outcomes 0 Mermond [7] New Caledonia, 2006–2007, inpatient Prospective cohort Patients aged >16 years admitted to the hospital with CAP 137 PCR, IFA 58 (median) 58.4 Aetiology of CAP, performance of tests, and assessment of vaccination-preventable proportion of causative organisms 5.8 Jennings [8] New Zealand, 1999–2000, inpatient Prospective cohort Patients aged >18 years admitted to the hospital with CAP 304 PCR, IFA, culture, serology 70 (median) 52 Aetiology of CAP and characteristics of viral pneumonia 6.8 (only reported for viral subset) Luchsinger [9] Chile, 2005–2007, inpatient and outpatient Prospective cohort Patients aged >18 years presenting with CAP 356 PCR, IFA, culture, serology 61 (median) 53.6 Aetiology of CAP and relationship between severity and pathogen 7.8 Takahashi [10] Vietnam, 2009–2010, inpatient Prospective cohort Patients aged >15 years admitted to the hospital with CAP 174 PCR 42 (median) 52 Incidence, aetiology and clinical features of CAP 9.8 Wiemken [11] USA, 2008–2011, inpatient ICU Prospective cohort Patients aged >18 years with CAP admitted to the ICU 393 PCR 52 (mean)# 56# Incidence of respiratory viruses in CAP patients in ICU Not reported Choi [2] Republic of Korea, 2010–2011, inpatient Retrospective analysis of a prospective cohort Patients aged >18 years admitted to the hospital with severe CAP 64 PCR, culture 49 (mean) 76.6 Role of viral infection in patients with severe CAP 32.8 Templeton [1] The Netherlands, 2000–2002, inpatient and outpatient Prospective cohort Patients aged >18 years with CAP 105 PCR, culture, IFA,
complement fixation>60 (50% of patients) 71 Aetiology of CAP 3.8 Musher [12] USA, 2011–2012, inpatient Prospective cohort Patients admitted to a Veteran Affairs hospital 259 PCR 70 (mean) 95.7 Yield of traditional and new diagnostic tests Not reported Shibli [34] Israel, 2006–2007, inpatient Prospective cohort Patients aged >18 years admitted to the hospital with CAP 126 PCR, DNA/RNA genomic extraction, serology 58.3 (mean) 57.9 Identify common pathogens causing CAP in hospitalised patients and evaluate correlation of aetiology and disease severity 3.96 Sangil [33] Spain, 2009–2010, inpatient Prospective cohort Patients aged >18 years admitted to the hospital with CAP 131 Multiplex PCR, serology 64.4 (mean) 68.7 Determine aetiology of CAP by adding PCR to conventional methods and describe clinical and laboratory features between patients with bacterial and viral CAP 5.3 Johansson [26] Sweden, 2004–2005, inpatient Prospective cohort Patients aged >18 years admitted to the hospital with CAP 184 PCR, serology, viral culture 61.3 (mean) 51 Determine aetiology of CAP among adults using new PCR platform and conventional methods 3.8 Huijskens [24] The Netherlands, 2008–2009, inpatient Prospective cohort Patients aged >18 years admitted to the hospital with CAP 408 PCR, serology 68 (median) 61.3 Evaluate potential for targeted diagnostics and directed treatment 39 Saito [32] Japan, 1999–2000, outpatient and inpatient Prospective cohort Patients aged >17 years admitted to the hospital with CAP 232 PCR, antigen immunoassay, serology 60 (mean) 57.8 Identify aetiology of CAP 1.7 Yin [36] China, 2008–2009, infectious disease outpatient clinic Prospective cohort Patients aged >18 years admitted to the hospital with CAP 215 PCR 36.1 (mean of those reported) 47.1 (of those with aetiologies) Evaluate Japanese Respiratory Society guidelines for identification of Mycoplasma pneumoniae 0 Diederen [20] The Netherlands, 1998–2000, inpatient Prospective cohort Patients aged >18 years admitted to the hospital with CAP 242 PCR, immunoassay/ELISA, serology Not reported Not reported Detection of respiratory viruses and Legionella by PCR in CAP patients 9.5 Hohenthal [21] Finland, 1999–2004, inpatient Prospective cohort Patients aged >16 years admitted to the hospital with CAP 384 PCR, immunoassay/IFA, serology 49.8 (mean) 52.3 Assess utility of rapid micro tests in different disease severities of CAP Not reported Lieberman [30] Israel, Nov 2004–March 2005 and Nov 2005–April 2006, inpatient Prospective cohort Patients aged >18 years admitted to the hospital with CAP 183 PCR 59.5 (mean) 57 Identify viruses in CAP versus control versus lower respiratory infections Not reported Kim [29] Republic of Korea, 2010–2013, inpatient and outpatient Retrospective cohort Patients aged >18 years admitted to the hospital with CAP 327 PCR, immunoassay for influenza antigen 67 (mean) in viral pneumonia;
70 (mean) in nonviral pneumonia72% in viral CAP;
78% in nonviral CAPInvestigate predictors of viral CAP 18.9 Karhu [28] Finland, 2008–2013, inpatient ICU Prospective cohort Patients aged >18 years admitted to the hospital with severe CAP 49 PCR 54 (median) 42.9 Evaluate presence and course of viral infections in ventilated patients using PCR 12.2 Holter [23] Norway, 2008–2011, inpatient Prospective cohort Patients aged >18 years admitted to the hospital with CAP 264 PCR, serology 66 (mean) 52 Describe aetiology and evaluate diagnostic results 3.7 Qu [31] China, 2010–2012, inpatient and outpatient Prospective cohort Patients aged >14 years admitted to the hospital with CAP 954 PCR 45.2 (mean) 56.6 Investigate respiratory virus aetiology in adolescents and adults with CAP, by age and PSI 0.4 Charles [17] Australia, 2004–2006, inpatient Prospective cohort Patients aged >18 years admitted to the hospital with CAP 865 PCR, serology for influenza 65.1 (mean) 60.7 Evaluate aetiology, severity assessment
tools and outcomes of CAP5.6 Viasus [35] Spain, 2010–2011, inpatient Prospective cohort Adults admitted to the hospital with CAP 747 PCR 65 (median) 56.8 Evaluate aetiology, clinical features and prognosis of CAP 8.2 Das [19] France, 2011–1012, ED Prospective cohort Patients aged >18 years presenting to the ED with CAP 125 PCR 65 (mean)# 49# Evaluate aetiology of CAP Not reported Jain [25] USA, 2010–2012, inpatient Prospective cohort Patients aged >18 years admitted to the hospital with CAP 2259 PCR, serology 57 (median) Not reported Population-based surveillance study of CAP aetiology 2 Johnstone [27] Canada, 2004–2006, inpatient Prospective cohort Patients aged >18 years admitted to the hospital with CAP 193 NAT, IFA 71 (median) 51 Describe the pathogens, clinical presentation
and outcomes of patients with CAP3 Cillóniz [18] Spain, 2003–2010, inpatient ICU Prospective cohort Patients aged >18 years admitted to the ICU with CAP 362 PCR, IFA 63 (mean) 64 Study the prevalence,
clinical characteristics and outcomes of severe CAP in the ICU10 CAP: community-acquired pneumonia; IFA: immunofluorescence assay; ED: emergency department; ICU: intensive care unit; PSI: pneumonia severity index; NAT: nucleic acid amplification tests. #: for all patients, including some not included in our analysis.
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Vol 25 Issue 140
Table of Contents
Viral infection in community-acquired pneumonia: a systematic review and meta-analysis
