Hospital-acquired Pneumonia and Ventilator-associated Pneumonia

Recent Advances in Epidemiology and Management

François Barbier; Antoine Andremont; Michel Wolff; Lila Bouadma

Disclosures

Curr Opin Pulm Med. 2013;19(3):216-228. 

In This Article

The Role of Virus in Ventilator-associated Pneumonia

The Herpesviridae herpes simplex virus (HSV) and cytomegalovirus (CMV) can cause viral reactivation pneumonia in intubated patients without a usual criterion for immune deficiencies.[65] HSV replication may be documented in tracheal/bronchial aspirates from 32 to 64% of patients requiring prolonged mechanical ventilation,[66–68] with subsequent histopathological evidence of HSV bronchopneumonitis in up to 21% of patients with worsening respiratory status.[68] Patients with ARDS and those receiving steroids may be at higher risk.[65] CMV reactivation is observed in ~30% of critically ill patients experiencing multiorgan failure and prolonged ICU stay,[69] most notably in survivors of severe bacterial sepsis, and may directly involve the lung. The incidence of histologically proven CMV pneumonia may reach 30% in ARDS patients with clinical deterioration suggesting VAC and negative bronchoalveolar lavage fluid (BALF) culture.[70] Acyclovir and gancyclovir are the main therapeutic options for HSV and CMV pneumonia, respectively, but both remain to be fully evaluated by appropriate randomized controlled trials (RCTs). A positive mimivirus (Acanthamoeba polyphaga) serology has been documented in 20% of patients with suspected VAP and was associated with an increased duration of mechanical ventilation and ICU stay,[71] but a direct role of mimivirus in VAP is uncertain.[72,73]

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