Bacterial and viral co-infections in community-acquired pneumonia in adults: a prospective study of multiple hospital centers

Abstract

Community-acquired pneumonia (CAP) is mostly caused by bacteria and viruses. Identifying pathogenic bacteria and viruses using traditional culture techniques is challenging. Therefore, multiplex real-time PCR (MPL-rPCR) has the capacity not only to concurrently identify the causative bacteria, atypical bacteria, and viruses but also to quantify their load and detect co-infections. This study was carried out on patients with CAP who were admitte to the Respiratory departments of Nguyen Tri Phuong Hospital, Nhan Dan Gia Dinh Hospital and University Medical Center, from April 2021 to March 2023, using a cross-sectional descriptive design in prospect. Sputum samples, evaluated by the Barlett scale, were collected and processed using the MPL-rPCR technique at Nam Khoa Company’s laboratory. Bacterial pathogens and viruses were detected at rates of 67.7% and 57.5% (p<0.05). Gram – negative bacteria included Klebsiella pneumoniae at 18.5%, Acinetobacter baumannii at 17.3%, and Haemophilus influenzae at 14.1%. Among Gram-positive bacteria, Streptococcus pneumoniae was found at 16.4%. The Epstein–Barr virus was the most frequently identified virus at 34.9%, followed by Cytomegalovirus at 16.7%, and Influenza virus type A at 10.3%. One sputum sample showed the presence of more than one bacterium or virus, with high rates observed for Epstein–Barr virus and Cytomegalovirus. Gram – negative bacteria are found in high proportions, and viruses were predominant, particularly Epstein–Barr virus, Cytomegalovirus, Influenza virus types A and B. Almost all viruses were co-infected with pathogenic bacteria, and multiple bacteria or viruses were identified in one sputum sample.