title: Cytomegalovirus and herpes simplex virus effect on the prognosis of mechanically ventilated patients suspected to have ventilator-associated pneumonia.
abstract: OBJECTIVE
  Cytomegalovirus (CMV) and herpes simplex virus (HSV) are common viruses that can affect critically ill patients who are not immunocompromised. The aim of this study was to determine whether the identification of CMV and/or HSV in mechanically ventilated critically ill patients suspected of having pneumonia was associated with an increased mortality.
  
  
  METHODS
  Prospective epidemiological study.
  
  
  METHODS
  Medical intensive care unit of a tertiary medical center.
  
  
  METHODS
  Ninety-three patients with suspected pneumonia.
  
  
  METHODS
  Patients with suspected pneumonia had bronchoalveolar lavage and blood samples taken to confirm the diagnosis. Antigenemia was used to detect CMV in the blood. Bronchoalveolar lavage samples were submitted to testing using quantitative real-time Polymerase Chain Reaction.
  
  
  RESULTS
  We identified 22 patients with a CMV infection, 26 patients with an HSV infection and 45 patients without CMV or HSV infection (control group). Mortality at day 60 was higher in patients with a CMV infection than in patients from the control group (55% vs. 20%, P<0.01). Mortality at day 60 was not significantly increased in the group with HSV infection. Duration of ICU stay and ICU mortality were significantly higher in patients with CMV infections when compared to patients from the control group, whereas ventilator free days were significantly lower in patients with CMV infections when compared to patients from the control group.
  
  
  CONCLUSIONS
  In critically ill patients, a CMV infection is associated with an increased mortality. Further interventional studies are needed to evaluate whether treatment could improve the prognosis.
authors.affiliation: Service d'Anesthésie-Réanimation Saint Eloi, Centre Hospitalier Universitaire, and INSERM Unité 1046, Université Montpellier 1, Montpellier, France. y-coisel@chu-montpellier.fr
authors.forename: Yannael
authors.initials: Y
authors.lastname: Coisel
authors.forename: Sabri
authors.initials: S
authors.lastname: Bousbia
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Forel
authors.forename: Sami
authors.initials: S
authors.lastname: Hraiech
authors.forename: Bernard
authors.initials: B
authors.lastname: Lascola
authors.forename: Antoine
authors.initials: A
authors.lastname: Roch
authors.forename: Christine
authors.initials: C
authors.lastname: Zandotti
authors.forename: Matthieu
authors.initials: M
authors.lastname: Million
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
authors.forename: Laurent
authors.initials: L
authors.lastname: Papazian
mesh_terms: D001992:Bronchoalveolar Lavage Fluid / Q000821:virology; D003587:Cytomegalovirus / Q000472:pathogenicity*; D017931:DNA Primers / Q000235:genetics; D004797:Enzyme-Linked Immunosorbent Assay; D005602:France; D006801:Humans; D016015:Logistic Models; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000401:mortality* / Q000821:virology*; D011379:Prognosis; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D018139:Simplexvirus / Q000472:pathogenicity*; D018709:Statistics, Nonparametric
chemical_list: D017931:DNA Primers