Occult herpes family viral infections are endemic in critically ill surgical patients
Occult herpes family viral infections are endemic in critically ill surgical patients
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DOI：
10.1097/01.ccm.0000070222.11325.c4
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发表时间：
2003-07-01
影响因子：
8.8
通讯作者：
Ferguson, RM
中科院分区：
文献类型：
--
作者：
Cook, CH;Martin, LC;Ferguson, RM
目的：多年来，疱疹家族病毒已被认为是免疫抑制移植或人类免疫缺陷病毒患者的病原体，但它们作为非免疫抑制危重患者的潜在病原体却很少受到关注。本研究的目的是确定慢性危重外科患者中疱疹家族病毒感染的患病率和危险因素。设计：前瞻性流行病学研究。设置：一所大型大学医院的 38 个床位的外科重症监护病房。患者：非免疫抑制重症监护病房患者在重症监护病房中停留超过或等于 5 天。干预措施：无；无；研究期间患者未接受抗病毒治疗。 测量和主要结果：每周进行巨细胞病毒 (CMV) 和单纯疱疹病毒培养、病毒血清学和 T 细胞计数。单纯疱疹或 CMV 呼吸道培养阳性的患病率（95% 置信区间）为 35%（22-49%）； 15%（5-25%）CMV培养阳性，23%（11-35%）单纯疱疹病毒培养阳性，1名患者呼吸道分泌物CMV和单纯疱疹病毒培养均为阳性。 CMV病毒血症的患病率仅为5.8%（1-10%）。尽管疾病严重程度评分相当，但与 CMV- 患者相比，CMV+ 患者的住院时间、重症监护病房住院时间和呼吸机依赖期更长。 CMV+ 患者的输血次数、类固醇暴露率和肝功能障碍的患病率也显着更高，并且在研究开始时全部为免疫球蛋白 6 阳性。相比之下，单纯疱疹病毒阳性患者的住院时间、重症监护病房住院时间和呼吸机依赖时间与未感染病毒的患者相当 (p > .05)。结论：慢性危重手术患者中隐匿性活动性疱疹家族病毒的患病率很高（22-49%）。尽管 CMV+ 患者的发病率明显高于 CMV- 患者，但这些病毒感染的临床意义尚不清楚。有几个因素表明致病性，但需要进一步研究来确定因果关系。
Objective: Herpes family viruses have been recognized as pathogens for many years in immunosuppressed transplant or human immunodeficiency virus patients, but they have garnered little attention as potential pathogens in the nonimmunosuppressed critically ill. The objective of this study was to define the prevalence of and risk factors for development of herpes family virus infection in chronic critically ill surgical patients.Design: Prospective epidemiologic study.Setting: A 38-bed surgical intensive care unit in a major university hospital.Patients: Nonimmunosuppressed intensive care unit patients in intensive care unit for greater than or equal to5 days.Interventions: None; patients received no antiviral treatment during the study.Measurements and Main Results: Weekly cultures for cytomegalovirus (CMV) and herpes simplex virus, viral serologies, and T-cell counts were performed. The prevalence (95% confidence interval) of positive respiratory cultures for herpes simplex or CMV was 35% (22-49%); 15% (5-25%) cultured positive for CMV, 23% (11-35%) cultured positive for herpes simplex virus, and one patient's respiratory secretions culturing positive for both CMV and herpes simplex virus. The prevalence of CMV viremia was only 5.8% (1-10%). CMV+ patients had longer hospital admissions, intensive care unit admissions, and periods of ventilator dependence than CMV- patients, despite having comparable severity of illness scores. CMV+ patients also had significantly higher numbers of blood transfusions, prevalence of steroid exposure, and prevalence of hepatic dysfunction, and all were immunoglobulin 6 positive at the beginning of the study. In contrast, herpes simplex virus-positive patients had lengths of hospital admissions, lengths of intensive care unit admissions, and periods of ventilator dependence comparable with patients without viral infections (p > .05).Conclusions: There is a significant prevalence (22-49%) of occult active herpes family viruses in chronic critically ill surgical patients. The clinical significance of these viral infections is unknown, although CMV+ patients have significantly higher morbidity rates than CMV- patients. Several factors suggest pathogenicity, but further study is needed to define causality.