Nosocomial viral ventilator-associated pneumonia in the intensive care unit: a prospective cohort study.
OBJECTIVE
To determine the incidence, risk factors, and clinical relevance of viral ventilator-associated pneumonia (VAP) in an adult intensive care unit (ICU).


METHODS
Prospective observational study.


METHODS
A 22-bed adult medical ICU in a university hospital.


METHODS
All consecutive adult patients ventilated more than 48 h in a 9-month period including regular seasonal viral infections.


METHODS
A tracheobronchial aspirate upon enrollment and at the time of VAP suspicion.


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.
Department of Medical Intensive Care, Caen University Hospital, 14033, Caen Cedex, France. daubin-c@chu-caen.fr
Cédric
C
Daubin
Sophie
S
Vincent
Astrid
A
Vabret
Damien
D
du Cheyron
Jean-Jacques
JJ
Parienti
Michel
M
Ramakers
François
F
Freymuth
Pierre
P
Charbonneau
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology* / Q000821:virology; D004267:DNA Viruses / Q000235:genetics / Q000302:isolation & purification; D004866:Equipment Contamination; D005260:Female; D005602:France / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011024:Pneumonia, Viral / Q000453:epidemiology / Q000209:etiology*; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012328:RNA Viruses / Q000235:genetics / Q000302:isolation & purification; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012307:Risk Factors; D013997:Time Factors; D012122:Ventilators, Mechanical / Q000009:adverse effects*