Nosocomial viral ventilator-associated pneumonia in the intensive care unit: a prospective cohort study
Nosocomial viral ventilator-associated pneumonia in the intensive care unit: a prospective cohort study
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DOI：
10.1007/s00134-005-2706-1
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发表时间：
2005-08-01
影响因子：
38.9
通讯作者：
Charbonneau, P
中科院分区：
文献类型：
--
作者：
Daubin, C;Vincent, S;Charbonneau, P
目的：确定成人重症监护病房（ICU）中病毒性呼吸机相关性肺炎（VAP）的发病率、危险因素和临床相关性。设计：前瞻性观察研究。地点：大学医院内设有 22 个床位的成人医疗 ICU。患者：所有连续 9 个月内通气时间超过 48 小时的成年患者，包括常规季节性病毒感染。干预措施：入组时和怀疑 VAP 时进行气管支气管抽吸。测量和结果：所有呼吸道标本均经过培养、间接免疫荧光测定以及 PCR 或 RT-PCR 进行病毒学评估。对患者进行随访直至出院或死亡。其中包括一百三十九名患者。入组后，25% 的患者（139 名患者中的 35 名）的气管支气管抽吸物中检测到呼吸道病毒。根据临床每日评估定义，VAP 的发生率为 28%（139 名患者中的 39 名）。 74% 的病例中记录到细菌，而 VAP 患者中没有遇到致病病毒感染的病例；然而，31% 的 VAP 呼吸道标本中检测到 1 型单纯疱疹病毒 (HSV 1) 感染（39 例中有 12 例）。结论：我们发现 VAP 患者 HSV-1 感染发生率较高；然而，根据本前瞻性队列研究中未发现呼吸道病毒诱发的 VAP 的情况进行评估，院内病毒性 VAP 在 ICU 中可能很少见。
Objective: To determine the incidence, risk factors, and clinical relevance of viral ventilator-associated pneumonia (VAP) in an adult intensive care unit (ICU). Design: Prospective observational study. Setting: A 22-bed adult medical ICU in a university hospital. Patients: All consecutive adult patients ventilated more than 48 h in a 9-month period including regular seasonal viral infections. Interventions: A tracheobronchial aspirate upon enrollment and at the time of VAP suspicion. Measurements and results: All respiratory specimens were tested in culture, indirect immunofluorescence assay, and PCR or RT-PCR for virological assessment. Patients were followed until ICU discharge or death. One hundred thirty-nine patients were included. Upon enrollment, a respiratory virus was detected in the tracheobronchial aspirate in 25% of patients (35 of 139). The incidence of VAP, defined according to clinical daily evaluation, was 28% (39 of 139 patients). A bacteria was documented in 74% of cases, whereas no case of a causative viral infection was encountered among VAP patients; however, herpes simplex virus type-1 (HSV 1) infection was detected in respiratory specimens of 31% of VAP (12 of 39). Conclusions: We found a high incidence of HSV-1 infection in VAP patients; however, nosocomial viral VAP is likely to be rare in ICU, as assessed by the absence of respiratory virus-induced VAP identified in this prospective cohort study.