Differential diagnosis of community-acquired bacterial pneumonia and viral lung injury in hospitalized adults

Clinical Microbiology and Antimicrobial Chemotherapy. 2023; 25(3):297-303

​ Strelkova D.A., Kupryushina O.A., Yasneva A.S., Rachina S.A., Avdeev S.N., Vlasenko A.E., Fedina L.V., Ivanova O.V., Kaledina I.V., Ananicheva N.A.
10.36488/cmac.2023.3.297-303
community-acquired pneumonia COVID-19 SARS-CoV-2 adults
Section
Personal Experience
Type
Original Article
Publication
Clinical Microbiology and Antimicrobial Chemotherapy. 2023; 25(3):297-303

Objective.

Identification of clinical, laboratory, and instrumental factors more common in bacterial pneumonia compared to viral pneumonia, including COVID-19.

Materials and Methods.

This retrospective case-control study included hospitalized adults with communityacquired bacterial pneumonia and viral lung injury, including COVID-19. Patients were included taking into account age, gender, hospitalization department (general ward or ICU), and Charlson comorbidity index. Clinical, demographic, laboratory, and instrumental data on admission were studied. Unadjusted odds ratios (OR) were calculated using univariate logistic regression (for quantitative indicators) and contingency table analysis (for categorical indicators); adjusted OR were calculated using multivariate logistic regression.

Results.

The community-acquired bacterial pneumonia group included 100 patients, and the viral lung injury group included 300 patients. Among the causative agents of bacterial pneumonia, Streptococcus pneumoniae was the most common; in the group of viral lung injury, SARS-CoV-2 predominated. In multivariate analysis, the presence of chills (OR and 95% CI: 22.1 [6.8–72.6], p < 0.001), unilateral infiltration according to X-ray or computer tomography (OR and 95% CI: 17.9 [ 7.3–44.1], p < 0.001), altered level of consciousness (OR and 95% CI: 3.2 [1.2–8.5], p = 0.019), use of vasopressors in the first 24 hours of hospitalization ( OR and 95% CI: 11.8 [2.5–55.9], p = 0.002), higher heart rate (OR and 95% CI: 9.1 [2.2–38.6], p = 0.003) and neutrophil/lymphocyte index (OR and 95% CI: 1.4 [1.1–1.9], p = 0.021), as well as the absence of fatigue (OR and 95% CI: 0.2 [0.08–0.40], p < 0.001) and lower total protein (OR and 95% CI: 0.2 [0.02–1.00], p = 0.049) are more typical for bacterial pneumonia compared to viral lung injury.

Conclusions.

Differential diagnosis between community-acquired bacterial pneumonia and viral lung injury, including COVID-19, requires a comprehensive analysis of clinical, laboratory, and instrumental data.

Daria А. Strelkova

I.M. Sechenov First Moscow State Medical University, Moscow, Russia

Kupryushina O.A.

I.M. Sechenov First Moscow State Medical University, Moscow, Russia

Yasneva A.S.

I.M. Sechenov First Moscow State Medical University, Moscow, Russia

Svetlana A. Rachina

I.M. Sechenov First Moscow State Medical University, Moscow, Russia

Avdeev S.N.

I.M. Sechenov First Moscow State Medical University, Moscow, Russia

Vlasenko A.E.

Samara State Medical University, Samara, Russia

Fedina L.V.

City Clinical Hospital named after S.S. Yudin, Moscow, Russia
Russian Medical Academy of Continuous Professional Education, Moscow, Russia

Ivanova O.V.

Branch No. 4 «1586 Military Clinical Hospital», Smolensk, Russia

Kaledina I.V.

City Clinical Hospital named after S.S. Yudin, Moscow, Russia

Ananicheva N.A.

City Clinical Hospital named after S.S. Yudin, Moscow, Russia

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