Adults hospitalised with acute respiratory illness rarely have detectable bacteria in the absence of COPD or pneumonia; viral infection predominates in a large prospective UK sample

Tristan W Clark, Marie-jo Medina, Sally Batham, Martin D Curran, Surendra Parmar, Karl G Nicholson, Tristan W Clark, Marie-jo Medina, Sally Batham, Martin D Curran, Surendra Parmar, Karl G Nicholson

Abstract

Objectives: Many adult patients hospitalised with acute respiratory illness have viruses detected but the overall importance of viral infection compared to bacterial infection is unclear.

Methods: Patients were recruited from two acute hospital sites in Leicester (UK) over 3 successive winters. Samples were taken for viral and bacterial testing.

Results: Of the 780 patients hospitalised with acute respiratory illness 345 (44%) had a respiratory virus detected. Picornaviruses were the most commonly isolated viruses (detected in 23% of all patients). Virus detection rates exceeded 50% in patients with exacerbation of asthma (58%), acute bronchitis and Influenza-like-illness (64%), and ranged from 30 to 50% in patients with an exacerbation of COPD (38%), community acquired pneumonia (36%) and congestive cardiac failure (31%). Bacterial detection was relatively frequent in patients with exacerbation of COPD and pneumonia (25% and 33% respectively) but was uncommon in all other groups. Antibiotic use was high across all clinical groups (76% overall) and only 21% of all antibiotic use occurred in patients with detectable bacteria.

Conclusions: Respiratory viruses are the predominant detectable aetiological agents in most hospitalised adults with acute respiratory illness. Antibiotic usage in hospital remains excessive including in clinical conditions associated with low rates of bacterial detection. Efforts at reducing excess antibiotic use should focus on these groups as a priority. Registered International Standard Controlled Trial Number: 21521552.

Keywords: Acute respiratory illness; Adults; Antibiotics; Hospitalisation; Respiratory viruses.

Copyright © 2014 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Figures

Figure 1
Figure 1
Trial profile. ILI, influenza-like illness.
Figure 2
Figure 2
Number and proportion of all patients with respiratory viruses detected (n = 780). *RSV, parainfluenza (types 1–4), human metapneumovirus (hMPV), coronavirus (group 1 and 2) and adenovirus. †Dual viral detections are detailed in the box below.
Figure 3
Figure 3
a. Proportions of respiratory viruses detected by clinical group (n = 780). ILI, influenza-like illness. Other viruses includes; RSV, parainfluenza (virus type 1–4), hMPV, coronaviruses (group 1 and 2), and adenovirus. b. Proportion of patients with viruses only detected, bacteria only detected, viruses and bacteria detected together and no pathogen detected, by clinical group (n = 780). ILI, influenza-like illness. Data represented are for all patients including those with incomplete sampling for bacteria.
Figure 4
Figure 4
Antibiotic use in patients by aetiology (n = 758). Mixed detection refers to the concurrent detection of viruses and bacteria in the same patient.

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