PCR-based diagnosis of respiratory virus in postsurgical septic patients: A preliminary study before SARS-CoV-2 pandemic

Respiratory viruses are part of the normal microbiota of the respiratory tract, which sometimes cause infection with/without respiratory insufficiency and the need for hospital or ICU admission. The aim of this study is to determine the prevalence of respiratory viruses in nontransplanted postoperative septic patients as well as lymphocyte count influence in their presence and its relationship to mortality. 223 nontransplanted postsurgical septic patients were recruited on the Intensive Care Unit (ICU) at Hospital Clínico Universitario de Valladolid prior to the SARS-COV-2 pandemic. Patients were split into 2 groups according to the presence/absence of respiratory viruses. Multivariate logistic regression analysis was used to identify independent factors related to positive respiratory virus PCR test. Respiratory viruses were isolated in 28.7% of patients. 28-day mortality was not significantly different between virus-positive and virus-negative groups. Logistic regression analysis revealed that lymphocyte count ≤ 928/µl is independently associated with a positive PCR result [OR 3.76, 95% CI (1.71–8.26), P = .001] adjusted by platelet count over 128,500/µL [OR 4.27, 95% CI (1.92–9.50) P < .001] and the presence of hypertension [OR 2.69, 95% CI (1.13–6.36) P = .025] as confounding variables. Respiratory viruses’ detection by using PCR in respiratory samples of nontransplanted postoperative septic patients is frequent. These preliminary results revealed that the presence of lymphopenia on sepsis diagnosis is independently associated to a positive virus result, which is not related to a higher 28-day mortality.

[1]  S. Calza,et al.  Factors Associated With Surgical Mortality and Complications Among Patients With and Without Coronavirus Disease 2019 (COVID-19) in Italy. , 2020, JAMA Surgery.

[2]  B. Fries,et al.  Review of Viral Testing (Polymerase Chain Reaction) and Antibody/Serology Testing for Severe Acute Respiratory Syndrome-Coronavirus-2 for the Intensivist , 2020, Critical Care Explorations.

[3]  P. Zhou,et al.  Microbiota in viral infection and disease in humans and farm animals , 2020, Progress in Molecular Biology and Translational Science.

[4]  Lijuan Xiong,et al.  Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients , 2020, EBioMedicine.

[5]  Jennifer E. Moore,et al.  Agency for Healthcare Research and Quality , 2020, Definitions.

[6]  G. Gao,et al.  A Novel Coronavirus from Patients with Pneumonia in China, 2019 , 2020, The New England journal of medicine.

[7]  Jeremiah R. Brown,et al.  The Association between Cytokines and 365-Day Readmission or Mortality in Adult Cardiac Surgery. , 2019, The journal of extra-corporeal technology.

[8]  Xuejun Ma,et al.  Respiratory virus associated with surgery in children patients , 2019, Respiratory Research.

[9]  R. Serra,et al.  Different inflammatory cytokines release after open and endovascular reconstructions influences wound healing , 2019, International wound journal.

[10]  O. Manuel,et al.  RNA respiratory viral infections in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice , 2019, Clinical transplantation.

[11]  A. Glatman-Freedman,et al.  A method to identify respiratory virus infections in clinical samples using next-generation sequencing , 2019, Scientific Reports.

[12]  S. Hoover,et al.  The Impact of Molecular Testing for Pathogens of Community-Acquired Pneumonia on Antibiotic Utilization. , 2019, South Dakota medicine : the journal of the South Dakota State Medical Association.

[13]  S. Voigt,et al.  Respiratory Virus Infections in Hematopoietic Cell Transplant Recipients , 2019, Front. Microbiol..

[14]  R. Kėvalas,et al.  Lower Airway Virology in Health and Disease—From Invaders to Symbionts , 2018, Medicina.

[15]  F. Carmona,et al.  Epidemiology of viral respiratory infections in children undergoing heart surgery , 2018, Progress in pediatric cardiology.

[16]  A. Presson,et al.  Respiratory Testing and Hospital Outcomes in Asymptomatic Infants Undergoing Heart Surgery , 2018, Pediatric Cardiology.

[17]  J. Houtman,et al.  Polymicrobial sepsis influences NK-cell-mediated immunity by diminishing NK-cell-intrinsic receptor-mediated effector responses to viral ligands or infections , 2018, PLoS pathogens.

[18]  A. Alvaro-Meca,et al.  Epidemiological trends of sepsis in the twenty-first century (2000–2013): an analysis of incidence, mortality, and associated costs in Spain , 2018, Population Health Metrics.

[19]  C. Arias,et al.  Human Virome. , 2018, Archives of medical research.

[20]  L. Danziger-Isakov,et al.  Respiratory Viral Infections in Solid Organ and Hematopoietic Stem Cell Transplantation , 2017, Clinics in Chest Medicine.

[21]  R. Wunderink,et al.  Severe Respiratory Viral Infections: New Evidence and Changing Paradigms. , 2017, Infectious disease clinics of North America.

[22]  C. Aldecoa,et al.  Quantification of Immune Dysregulation by Next-generation Polymerase Chain Reaction to Improve Sepsis Diagnosis in Surgical Patients , 2017, Annals of surgery.

[23]  Y. Yazdanpanah,et al.  Impact of respiratory viruses in hospital-acquired pneumonia in the intensive care unit: A single-center retrospective study , 2017, Journal of Clinical Virology.

[24]  Wouter A. A. de Steenhuijsen Piters,et al.  The microbiota of the respiratory tract: gatekeeper to respiratory health , 2017, Nature Reviews Microbiology.

[25]  Alan E. Jones,et al.  Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 , 2017, Intensive Care Medicine.

[26]  T. Puhakka,et al.  The relationship of serum vitamins A, D, E and LL-37 levels with allergic status, tonsillar virus detection and immune response , 2017, PloS one.

[27]  M. Younis,et al.  Hospital-related cost of sepsis: A systematic review. , 2017, The Journal of infection.

[28]  Seemalata Jain Epidemiology of Viral Pneumonia , 2016, Clinics in Chest Medicine.

[29]  R. Bellomo,et al.  Sepsis: frontiers in diagnosis, resuscitation and antibiotic therapy , 2016, Intensive Care Medicine.

[30]  C. Huttenhower,et al.  The healthy human microbiome , 2016, Genome Medicine.

[31]  K. Hillman,et al.  Incidence and mortality of postoperative sepsis in New South Wales, Australia, 2002-2009. , 2016, Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine.

[32]  R. Bellomo,et al.  The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). , 2016, JAMA.

[33]  S. Passos,et al.  Detection of Respiratory Viruses in Nasopharyngeal Swab and Adenoid Tissue from Children Submitted to Adenoidectomy: Pre- and Postoperative Analysis , 2014, International Archives of Otorhinolaryngology.

[34]  S. Olofsson,et al.  PCR for detection of respiratory viruses: seasonal variations of virus infections , 2011, Expert review of anti-infective therapy.

[35]  Susan M. Huse,et al.  Variability and Diversity of Nasopharyngeal Microbiota in Children: A Metagenomic Analysis , 2011, PloS one.

[36]  J. Mahony Detection of Respiratory Viruses by Molecular Methods , 2008, Clinical Microbiology Reviews.

[37]  C. Uiterwaal,et al.  Respiratory Pathogens in Children with and without Respiratory Symptoms , 2008, The Journal of Pediatrics.

[38]  Margaret A Dudeck,et al.  CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. , 2008, American journal of infection control.

[39]  M. Levy,et al.  Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain. , 2008, JAMA.

[40]  C. Scagnolari,et al.  Detection and typing by molecular techniques of respiratory viruses in children hospitalized for acute respiratory infection in Rome, Italy , 2007, Journal of medical virology.

[41]  J. Parienti,et al.  Epidemiology and clinical outcome of virus-positive respiratory samples in ventilated patients: a prospective cohort study , 2006, Critical care.

[42]  L. Lorente,et al.  Central venous catheter-related infection in a prospective and observational study of 2,595 catheters , 2005, Critical care.

[43]  Joan L. Robinson,et al.  Colonization and infection of the respiratory tract: What do we know? , 2004, Paediatrics & child health.

[44]  Duncan Young,et al.  Epidemiology of severe sepsis occurring in the first 24 hrs in intensive care units in England, Wales, and Northern Ireland , 2003, Critical care medicine.

[45]  Mitchell M. Levy,et al.  2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference , 2003, Intensive Care Medicine.

[46]  E. Faist,et al.  Clinical review: Immunodepression in the surgical patient and increased susceptibility to infection , 2002, Critical care.

[47]  N. Manito,et al.  GUIAS DE ACTUACION CLINICA DE LA SOCIEDAD ESPANOLA DE CARDIOLOGIA. TRASPLANTE CARDIACO Y DE CORAZON-PULMONES , 1999 .

[48]  A. Herrera,et al.  [Postoperative mortality in a general hospital]. , 1997, Revista espanola de anestesiologia y reanimacion.

[49]  J. Vincent,et al.  The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure , 1996, Intensive Care Medicine.

[50]  W. Knaus,et al.  APACHE II: a severity of disease classification system. , 1985 .

[51]  D. Maki,et al.  A semiquantitative culture method for identifying intravenous-catheter-related infection. , 1977, The New England journal of medicine.

[52]  F. Saldías Peñafiel,et al.  [Features of community-acquired pneumonia in immunocompetent hospitalized adults according to the causal agent]. , 2018, Revista médica de Chile (Impresa).

[53]  E. de Jonge,et al.  Respiratory Viruses in Invasively Ventilated Critically Ill Patients—A Prospective Multicenter Observational Study , 2018, Critical care medicine.

[54]  T. Karl,et al.  Impact of Viral Respiratory Pathogens on Outcomes After Pediatric Cardiac Surgery , 2017, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[55]  L. Krishnan,et al.  Introduction to the immune system. , 2013, Methods in molecular biology.

[56]  CM Torio,et al.  National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2013: Statistical Brief #204 , 2006 .

[57]  L. Fernández Pineda,et al.  [Practice Guidelines of the Spanish Society of Cardiology in the postoperative course of congenital heart diseases]. , 2000, Revista Española de Cardiología.

[58]  M. Reddehase Immunity to viruses. , 1989, Immunology today.