• Alexis Maillard, Jérôme Le Goff, Mariame Barry, Virginie Lemiale, Séverine Mercier-Delarue, Alexandre Demoule, Linda Feghoul, Samir Jaber, Kada Klouche, Achille Kouatchet, Laurent Argaud, Francois Barbier, Naike Bigé, Anne-Sophie Moreau, Emmanuel Canet, Frédéric Pène, Maud Salmona, Djamel Mokart, and Elie Azoulay.
• Service de Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris, Paris.
• Chest. 2023 Dec 1; 164 (6): 136413771364-1377.

BackgroundIn immunocompromised patients with acute respiratory failure (ARF), the clinical significance of respiratory virus detection in the nasopharynx remains uncertain.Research QuestionIs viral detection in nasopharyngeal swabs associated with causes and outcomes of ARF in immunocompromised patients?Study Design And MethodsThis preplanned post hoc analysis of a randomized controlled trial enrolled immunocompromised patients admitted to 32 ICUs for ARF between May 2016 and December 2017. Nasopharyngeal swabs sampled at inclusion were assessed for 23 respiratory pathogens using multiplex polymerase chain reaction (PCR) assay. Causes of ARF were established by managing physicians and were reviewed by three expert investigators masked to the multiplex PCR assay results. Associations between virus detection in nasopharyngeal swabs, causes of ARF, and composite outcome of day 28 mortality, invasive mechanical ventilation (IMV), or both were assessed.ResultsAmong the 510 sampled patients, the multiplex PCR assay results were positive in 103 patients (20.2%), and a virus was detected in 102 samples: rhinoviruses or enteroviruses in 35.5%, coronaviruses in 10.9%, and flu-like viruses (influenza virus, parainfluenza virus, respiratory syncytial virus, human metapneumovirus) in 52.7%. The cause of ARF varied significantly according to the results of the multiplex PCR assay, especially the proportion of viral pneumonia: 50.0% with flu-like viruses, 14.0% with other viruses, and 3.6% when no virus was detected (P < .001). No difference was found in the composite outcome of day 28 mortality, IMV, or both according to positive assay findings (54.9% vs 54.7%; P = .965). In a pre-established subgroup analysis, flu-like virus detection was associated with a higher rate of day 28 mortality, IMV, or both among recipients of allogeneic hematopoietic stem cell transplantation compared with those without detected virus.InterpretationIn immunocompromised patients with ARF, the results of nasopharyngeal multiplex PCR assays are not associated with IMV or mortality. A final diagnosis of viral pneumonia is retained in one-third of patients with positive assay results and in one-half of the patients with a flu-like virus.Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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