Nosocomial viral ventilator-associated pneumonia in the intensive care unit: a prospective cohort study

Abstract

ObjectiveTo determine the incidence, risk factors, and clinical relevance of viral ventilator-associated pneumonia (VAP) in an adult intensive care unit (ICU).DesignProspective observational study.SettingA 22-bed adult medical ICU in a university hospital.PatientsAll consecutive adult patients ventilated more than 48 h in a 9-month period including regular seasonal viral infections.InterventionsA tracheobronchial aspirate upon enrollment and at the time of VAP suspicion.Measurements and resultsAll 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).ConclusionsWe 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.