Molecular detection of respiratory viruses in immunocopromised ICU patients: incidence and meaning.
OBJECTIVE
Prospective single-center study to assess the sensitivity and clinical relevance of molecular testing for respiratory viruses in critically ill immunocompromised patients with acute respiratory failure (ARF).


METHODS
100 consecutive critically ill immunocompromised patients with ARF in 2007-2009. Among them, 65 had hematologic malignancies (including 14 hematopoietic stem cell transplant recipients), 22 had iatrogenic immunosuppression, and 13 had solid malignancies. A multiplex molecular assay (MMA) was added to the usual battery of tests performed to look for causes of ARF.


RESULTS
Nasopharyngeal aspirates and/or bronchoalveolar lavage fluid were tested for respiratory viruses using both the MMA and immunofluorescence. A virus was detected in 47 (47%) patients using the MMA and 8 (8%) patients using immunofluorescence (P = 0.006). MMA-positive and MMA-negative patients had similar clinical and radiographic presentations and were not significantly different for the use of ventilatory support (58% vs. 76%, P = 0.09), occurrence of shock (43% vs. 53%, P = 0.41), use of renal replacement therapy (26% vs. 23%, P = 0.92), SAPS II (35 [26-44] vs. 38 [27-50], P = 0.36), time spent in the ICU (6 vs. 7 days, P = 0.35), or ICU mortality (17% vs. 28%, P = 0.27). Using MMA, a virus was found in 6 of the 12 patients with no diagnosis at the end of the etiologic investigations.


CONCLUSIONS
In critically ill immunocompromised patients, an MMA was far more sensitive than immunofluorescence for respiratory virus detection. Patients with RVs detected in the respiratory tract had the same clinical characteristics and outcomes as other patients.
AP-HP, Hôpital Saint-Louis, Medical ICU, 1 Avenue Claude Vellefaux, 75010 Paris, France. david.schnell@sls.aphp.fr
David
D
Schnell
Jérôme
J
Legoff
Eric
E
Mariotte
Amélie
A
Seguin
Emmanuel
E
Canet
Virginie
V
Lemiale
Michael
M
Darmon
Benoît
B
Schlemmer
François
F
Simon
Elie
E
Azoulay
D000208:Acute Disease; D000328:Adult; D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000821:virology; D005260:Female; D005455:Fluorescent Antibody Technique; D019337:Hematologic Neoplasms / Q000150:complications / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D060885:Multiplex Polymerase Chain Reaction / Q000379:methods; D009305:Nasopharynx / Q000821:virology; D009894:Opportunistic Infections / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D012131:Respiratory Insufficiency / Q000276:immunology / Q000821:virology*; D012141:Respiratory Tract Infections / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D014777:Virus Diseases / Q000150:complications / Q000175:diagnosis* / Q000276:immunology