Open Access Research article

Inflammatory response in mixed viral-bacterial community-acquired pneumonia

Salvador Bello1*, Elisa Mincholé1, Sergio Fandos1, Ana B Lasierra2, María A Ruiz3, Ana L Simon1, Carolina Panadero1, Carlos Lapresta4, Rosario Menendez5 and Antoni Torres6

Author Affiliations

1 Servicio de Neumologia, Hospital Universitario Miguel Servet, Paseo Isabel La Católica, 1-3, 50009 Zaragoza, Spain

2 Servicio de Bioquimica Clinica, Hospital Universitario Miguel Servet, Zaragoza, Spain

3 Servicio de Microbiologia, Hospital Universitario Miguel Servet, Zaragoza, Spain

4 Servicio de Medicina Preventiva, Hospital Universitario Miguel Servet, Zaragoza, Spain

5 Servicio de Neumologia, ISS/Hospital Universitario y Politécnico La Fe CIBERES, Valencia, Spain

6 Servicio de Neumologia, Hospital Clinic i Provincial de Barcelona – Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona (UB) - Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain

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BMC Pulmonary Medicine 2014, 14:123  doi:10.1186/1471-2466-14-123

Published: 29 July 2014



The role of mixed pneumonia (virus + bacteria) in community-acquired pneumonia (CAP) has been described in recent years. However, it is not known whether the systemic inflammatory profile is different compared to monomicrobial CAP. We wanted to investigate this profile of mixed viral-bacterial infection and to compare it to monomicrobial bacterial or viral CAP.


We measured baseline serum procalcitonin (PCT), C reactive protein (CRP), and white blood cell (WBC) count in 171 patients with CAP with definite etiology admitted to a tertiary hospital: 59 (34.5%) bacterial, 66 (39.%) viral and 46 (27%) mixed (viral-bacterial).


Serum PCT levels were higher in mixed and bacterial CAP compared to viral CAP. CRP levels were higher in mixed CAP compared to the other groups. CRP was independently associated with mixed CAP. CRP levels below 26 mg/dL were indicative of an etiology other than mixed in 83% of cases, but the positive predictive value was 45%. PCT levels over 2.10 ng/mL had a positive predictive value for bacterial-involved CAP versus viral CAP of 78%, but the negative predictive value was 48%.


Mixed CAP has a different inflammatory pattern compared to bacterial or viral CAP. High CRP levels may be useful for clinicians to suspect mixed CAP.

Community-acquired pneumonia; Viral pneumonia; Biomarkers