What role do viruses play in nosocomial pneumonia?

Luyt, Charles‐Édouard; Bréchot, Nicolas; Chastre, Jean

doi:10.1097/qco.0000000000000049

Cited by 25 publications

(27 citation statements)

References 48 publications

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“…Residing latently in sensory neurons, HSV reactivates in states of reduced immunocompetence [2]. Several studies have shown that HSV-1 reactivation and active replication in the respiratory tract are common in mechanically ventilated intensive care unit (ICU) patients even without underlying immunosuppression, with reported rates of 5 to 64% [3]. Ong et al, in the largest study available to date, detected active HSV replication in 27% of 393 ventilated ICU patients, which was associated with a nearly twofold increase in hospital mortality (41% vs 24%, p = 0.002) [4].…”

Section: Introductionmentioning

confidence: 99%

Impact of acyclovir use on survival of patients with ventilator-associated pneumonia and high load herpes simplex virus replication

et al. 2020

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Background: Herpes simplex virus (HSV) replication can be detected in the respiratory secretions of a high proportion of ventilated intensive care unit (ICU) patients. However, the clinical significance remains poorly defined. We investigated whether patients with ventilator-associated pneumonia not responding to antibiotics and in whom high levels of HSV could be detected in respiratory secretions benefit from acyclovir treatment. Methods: Respiratory secretions (bronchoalveolar lavage fluid or tracheal aspirates) were tested for HSV replication by quantitative real-time PCR. ICU survival times, clinical parameters, and radiographic findings were retrospectively compared between untreated and acyclovir treated patients with high (> 10 5 HSV copies/mL) and low (10 3 -10 5 HSV copies/mL) viral load.Results: Fifty-seven low and 69 high viral load patients were identified. Fewer patients with high viral load responded to antibiotic treatment (12% compared to 40% of low load patients, p = 0.001). Acyclovir improved median ICU survival (8 vs 22 days, p = 0.014) and was associated with a significantly reduced hazard ratio for ICU death (HR = 0.31, 95% CI 0.11-0.92, p = 0.035) in high load patients only. Moreover, circulatory and pulmonary oxygenation function of high load patients improved significantly over the course of acyclovir treatment: mean norepinephrine doses decreased from 0.05 to 0.02 μg/kg body weight/min between days 0 and 6 of treatment (p = 0.049), and median PaO 2 /FiO 2 ratio increased from 187 to 241 between day 3 and day 7 of treatment (p = 0.02). Chest radiographic findings also improved significantly (p < 0.001). Conclusions: In patients with ventilator-associated pneumonia, antibiotic treatment failure, and high levels of HSV replication, acyclovir treatment was associated with a significantly longer time to death in the ICU and improved circulatory and pulmonary function. This suggests a causative role for HSV in this highly selected group of patients.

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Section: Introductionmentioning

confidence: 99%

Impact of acyclovir use on survival of patients with ventilator-associated pneumonia and high load herpes simplex virus replication

et al. 2020

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“…Viruses play important roles in respiratory tract infections. [1][2][3][4] Recently, several novel respiratory viruses have emerged, including the 2009 pandemic influenza virus A(H1N1)pdm09, 5 the avian influenza viruses A(H7N9) and A(H5N6), [6][7][8] and the Middle East Respiratory Syndrome (MERS) coronavirus. 9 The novel avian influenza viruses and the MERS coronavirus are associated with high mortality rates of over 30%.…”

Section: Introductionmentioning

confidence: 99%

Additional molecular testing of saliva specimens improves the detection of respiratory viruses

Yip

et al. 2017

Emerging Microbes & Infections

129

140

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Emerging infectious diseases in humans are often caused by respiratory viruses such as pandemic or avian influenza viruses and novel coronaviruses. Microbiological testing for respiratory viruses is important for patient management, infection control and epidemiological studies. Nasopharyngeal specimens are frequently tested, but their sensitivity is suboptimal. This study evaluated the incremental benefit of testing respiratory viruses in expectorated saliva using molecular assays. A total of 258 hospitalized adult patients with suspected respiratory infections were included. Their expectorated saliva was collected without the use of any special devices. In the first cohort of 159 patients whose nasopharyngeal aspirates (NPAs) tested positive for respiratory viruses during routine testing, the viral load was measured using quantitative reverse transcription PCR. Seventeen percent of the patients (27/159) had higher viral loads in the saliva than in the NPA. The second cohort consisted of 99 patients whose NPAs tested negative for respiratory viruses using a direct immunofluorescence assay. Their NPA and saliva specimens were additionally tested using multiplex PCR. In these patients, the concordance rate by multiplex PCR between NPA and saliva was 83.8%. Multiplex PCR detected viruses in saliva samples from 16 patients, of which nine (56.3%) had at least one virus that was not detected in the NPA. Decisions on antiviral or isolation precautions would be affected by salivary testing in six patients. Although NPAs have high viral loads and remain the specimen of choice for most patients with respiratory virus infections, supplementary molecular testing of saliva can improve the clinical management of these patients.

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“…Along with recent advantages in diagnosis (6), new challenges have occurred in the management of viral infections (true disease versus colonization), especially among high risk patients (such as immunocompromised hosts). Also, there are limited data regarding the clinical importance of isolated virus (such as HHVs) in lower respiratory tract of critically ill individuals.…”

Section: Introductionmentioning

confidence: 99%

“…Pulmonary viral infections (primary or reactivation) (6,11,12) may be accompanied by susceptibility to certain bacterial or fungal infections (4,13,14) and further complications (15)(16)(17). time of reactivation, the virus may be excreted through the respiratory and digestive tract (17).…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Human Herpes Viruses in Bronchoalveolar Lavage of Critically Ill Children Undergoing Mechanical Ventilation at a Pediatric Intensive Care Unit

Amanati

Karimi

Fahimzad

et al. 2018

Arch Pediatr Infect Dis

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Background: Critically ill children at the intensive care unit frequently develop hospital-acquired pneumonia (HAP). Human herpes viruses (HHVs), primarily or by reactivation may cause bronchopneumonitis in mechanically ventilated patients. The exact prevalence and role of HHVs in morbidity and mortality of pediatric patients undergoing mechanical ventilation is unclear. The current study was conducted to evaluate the prevalence of 5 Herpes viruses by polymerase chain reaction (PCR) method in bronchoalveolar lavage (BAL) samples in critically ill children at a pediatric intensive care unit (PICU). Methods: Overall, 140 bronchoalveolar lavage samples from 83 mechanically ventilated cases were studied. Samples were taken via the mini-BAL technique. Samples were analyzed by qualitative PCR for detection of herpes simplex virus type 1 and 2 (HSV1/HSV2), human herpes virus type 6 and 7 (HHV6/HHV7), Ebstein-Barr virus (EBV), and cytomegalovirus (CMV).

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What role do viruses play in nosocomial pneumonia?

Cited by 25 publications

References 48 publications

Impact of acyclovir use on survival of patients with ventilator-associated pneumonia and high load herpes simplex virus replication

Impact of acyclovir use on survival of patients with ventilator-associated pneumonia and high load herpes simplex virus replication

Additional molecular testing of saliva specimens improves the detection of respiratory viruses

Prevalence of Human Herpes Viruses in Bronchoalveolar Lavage of Critically Ill Children Undergoing Mechanical Ventilation at a Pediatric Intensive Care Unit

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