Download PDF
Semin Respir Crit Care Med 2022; 43(02): 310-318
DOI: 10.1055/s-0041-1740981
Review Article

Viral Ventilator-Associated Pneumonia/Hospital-Acquired Pneumonia

Charles-Edouard Luyt
1   Service de Médecine Intensive Réanimation, Sorbonne Université, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris
2   INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris
,
Guillaume Hékimian
1   Service de Médecine Intensive Réanimation, Sorbonne Université, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris
2   INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris
,
Nicolas Bréchot
1   Service de Médecine Intensive Réanimation, Sorbonne Université, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris
2   INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris
,
Jean Chastre
1   Service de Médecine Intensive Réanimation, Sorbonne Université, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris
2   INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Among the viruses possibly responsible for hospital-acquired and ventilator-associated pneumonia, herpes simplex virus (HSV) is probably the most often involved: HSV reactivation is frequent in intensive care unit patients, and lung parenchymal infection (HSV bronchopneumonitis) has been well described, either using cytological signs of parenchymal involvement in cells obtained during bronchoalveolar lavage or using HSV virus load in the lower respiratory tract. Although treating patients with HSV bronchopneumonitis may be recommended, based on expert opinion, prophylactic or preemptive treatment of HSV reactivation should be avoided. Ventilator-associated pneumonia due to cytomegalovirus (CMV) is less frequent than HSV bronchopneumonitis, and more difficult to diagnose. No data exists on the impact of antiviral treatment on CMV pneumonia. The involvement of respiratory viruses has been described in patients with healthcare-associated pneumonia and hospital-acquired pneumonia, but their role in ventilator-associated pneumonia is not clear.

Keywords

viral infection - herpes simplex virus - cytomegalovirus - respiratory viruses - mechanical ventilation


Publication History

Article published online:
31 January 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Jennings LC, Anderson TP, Beynon KA. et al. Incidence and characteristics of viral community-acquired pneumonia in adults. Thorax 2008; 63 (01) 42-48
    CrossrefPubMedGoogle Scholar
  • 2 Hotchkiss RS, Monneret G, Payen D. Immunosuppression in sepsis: a novel understanding of the disorder and a new therapeutic approach. Lancet Infect Dis 2013; 13 (03) 260-268
    CrossrefPubMedGoogle Scholar
  • 3 Luyt CE, Combes A, Deback C. et al. Herpes simplex virus lung infection in patients undergoing prolonged mechanical ventilation. Am J Respir Crit Care Med 2007; 175 (09) 935-942
    CrossrefPubMedGoogle Scholar
  • 4 Limaye AP, Kirby KA, Rubenfeld GD. et al. Cytomegalovirus reactivation in critically ill immunocompetent patients. JAMA 2008; 300 (04) 413-422
    CrossrefPubMedGoogle Scholar
  • 5 Libert N, Bigaillon C, Chargari C. et al. Epstein-Barr virus reactivation in critically ill immunocompetent patients. Biomed J 2015; 38 (01) 70-76
    CrossrefPubMedGoogle Scholar
  • 6 Ong DSY, Bonten MJM, Spitoni C. et al; Molecular Diagnosis and Risk Stratification of Sepsis Consortium. Epidemiology of multiple herpes viremia in previously immunocompetent patients with septic shock. Clin Infect Dis 2017; 64 (09) 1204-1210
    CrossrefPubMedGoogle Scholar
  • 7 Coisel Y, Bousbia S, Forel J-M. et al. Cytomegalovirus and herpes simplex virus effect on the prognosis of mechanically ventilated patients suspected to have ventilator-associated pneumonia. PLoS One 2012; 7 (12) e51340
    CrossrefPubMedGoogle Scholar
  • 8 Li X, Huang Y, Xu Z. et al. Cytomegalovirus infection and outcome in immunocompetent patients in the intensive care unit: a systematic review and meta-analysis. BMC Infect Dis 2018; 18 (01) 289
    CrossrefPubMedGoogle Scholar
  • 9 Bruynseels P, Jorens PG, Demey HE. et al. Herpes simplex virus in the respiratory tract of critical care patients: a prospective study. Lancet 2003; 362 (9395): 1536-1541
    CrossrefPubMedGoogle Scholar
  • 10 Porteous C, Bradley JA, Hamilton DN, Ledingham IM, Clements GB, Robinson CG. Herpes simplex virus reactivation in surgical patients. Crit Care Med 1984; 12 (08) 626-628
    CrossrefPubMedGoogle Scholar
  • 11 Ong GM, Lowry K, Mahajan S. et al. Herpes simplex type 1 shedding is associated with reduced hospital survival in patients receiving assisted ventilation in a tertiary referral intensive care unit. J Med Virol 2004; 72 (01) 121-125
    CrossrefPubMedGoogle Scholar
  • 12 Nash G. Necrotizing tracheobronchitis and bronchopneumonia consistent with herpetic infection. Hum Pathol 1972; 3 (02) 283-291
    CrossrefPubMedGoogle Scholar
  • 13 Luyt C-E, Bréchot N, Chastre J. What role do viruses play in nosocomial pneumonia?. Curr Opin Infect Dis 2014; 27 (02) 194-199
    CrossrefPubMedGoogle Scholar
  • 14 Simoons-Smit AM, Kraan EM, Beishuizen A, Strack van Schijndel RJ, Vandenbroucke-Grauls CM. Herpes simplex virus type 1 and respiratory disease in critically-ill patients: real pathogen or innocent bystander?. Clin Microbiol Infect 2006; 12 (11) 1050-1059
    CrossrefPubMedGoogle Scholar
  • 15 Tuxen DV, Cade JF, McDonald MI, Buchanan MR, Clark RJ, Pain MC. Herpes simplex virus from the lower respiratory tract in adult respiratory distress syndrome. Am Rev Respir Dis 1982; 126 (03) 416-419
    PubMedGoogle Scholar
  • 16 Linssen CFM, Jacobs JA, Stelma FF. et al. Herpes simplex virus load in bronchoalveolar lavage fluid is related to poor outcome in critically ill patients. Intensive Care Med 2008; 34 (12) 2202-2209
    CrossrefPubMedGoogle Scholar
  • 17 Tuxen DV, Wilson JW, Cade JF. Prevention of lower respiratory herpes simplex virus infection with acyclovir in patients with the adult respiratory distress syndrome. Am Rev Respir Dis 1987; 136 (02) 402-405
    CrossrefPubMedGoogle Scholar
  • 18 Hagel S, Scherag A, Schuierer L. et al. Effect of antiviral therapy on the outcomes of mechanically ventilated patients with herpes simplex virus detected in the respiratory tract: a systematic review and meta-analysis. Crit Care 2020; 24 (01) 584
    CrossrefPubMedGoogle Scholar
  • 19 Luyt CE, Forel JM, Hajage D. et al; Preemptive Treatment for Herpesviridae Study Group, Réseau Européen de Recherche en Ventilation Artificielle Network. Acyclovir for mechanically ventilated patients with herpes simplex virus oropharyngeal reactivation: a randomized clinical trial. JAMA Intern Med 2020; 180 (02) 263-272
    CrossrefPubMedGoogle Scholar
  • 20 Papazian L, Fraisse A, Garbe L. et al. Cytomegalovirus. An unexpected cause of ventilator-associated pneumonia. Anesthesiology 1996; 84 (02) 280-287
    CrossrefPubMedGoogle Scholar
  • 21 Papazian L, Doddoli C, Chetaille B. et al. A contributive result of open-lung biopsy improves survival in acute respiratory distress syndrome patients. Crit Care Med 2007; 35 (03) 755-762
    CrossrefPubMedGoogle Scholar
  • 22 Chiche L, Forel J-M, Roch A. et al. Active cytomegalovirus infection is common in mechanically ventilated medical intensive care unit patients. Crit Care Med 2009; 37 (06) 1850-1857
    CrossrefPubMedGoogle Scholar
  • 23 Papazian L, Jaber S, Hraiech S. et al; Preemptive Herpesviridae Treatment Study Group, REVA Network. Preemptive ganciclovir for mechanically ventilated patients with cytomegalovirus reactivation. Ann Intensive Care 2021; 11 (01) 33
    CrossrefPubMedGoogle Scholar
  • 24 Hall CB, Douglas Jr RG, Geiman JM, Messner MK. Nosocomial respiratory syncytial virus infections. N Engl J Med 1975; 293 (26) 1343-1346
    CrossrefPubMedGoogle Scholar
  • 25 Aitken C, Jeffries DJ. Nosocomial spread of viral disease. Clin Microbiol Rev 2001; 14 (03) 528-546
    CrossrefPubMedGoogle Scholar
  • 26 Limaye AP, Stapleton RD, Peng L. et al. Effect of ganciclovir on IL-6 levels among cytomegalovirus-seropositive adults with critical illness: a randomized clinical trial. JAMA 2017; 318 (08) 731-740
    CrossrefPubMedGoogle Scholar
  • 27 Cowley NJ, Owen A, Shiels SC. et al. Safety and efficacy of antiviral therapy for prevention of cytomegalovirus reactivation in immunocompetent critically ill patients: a randomized clinical trial. JAMA Intern Med 2017; 177 (06) 774-783
    CrossrefPubMedGoogle Scholar
  • 28 Horcajada JP, Pumarola T, Martínez JA. et al. A nosocomial outbreak of influenza during a period without influenza epidemic activity. Eur Respir J 2003; 21 (02) 303-307
    CrossrefPubMedGoogle Scholar
  • 29 Choi S-H, Hong S-B, Ko G-B. et al. Viral infection in patients with severe pneumonia requiring intensive care unit admission. Am J Respir Crit Care Med 2012; 186 (04) 325-332
    CrossrefPubMedGoogle Scholar
  • 30 Kim ES, Park KU, Lee SH. et al. Comparison of viral infection in healthcare-associated pneumonia (HCAP) and community-acquired pneumonia (CAP). PLoS One 2018; 13 (02) e0192893
    CrossrefPubMedGoogle Scholar
  • 31 Loubet P, Voiriot G, Houhou-Fidouh N. et al. Impact of respiratory viruses in hospital-acquired pneumonia in the intensive care unit: a single-center retrospective study. J Clin Virol 2017; 91: 52-57
    CrossrefPubMedGoogle Scholar
  • 32 Daubin C, Vincent S, Vabret A. et al. Nosocomial viral ventilator-associated pneumonia in the intensive care unit: a prospective cohort study. Intensive Care Med 2005; 31 (08) 1116-1122
    CrossrefPubMedGoogle Scholar
  • 33 Costa C, Sidoti F, Saldan A. et al. Clinical impact of HSV-1 detection in the lower respiratory tract from hospitalized adult patients. Clin Microbiol Infect 2012; 18 (08) E305-E307
    CrossrefPubMedGoogle Scholar
  • 34 Camps K, Jorens PG, Demey HE, Pattyn SR, Ieven M. Clinical significance of herpes simplex virus in the lower respiratory tract of critically ill patients. Eur J Clin Microbiol Infect Dis 2002; 21 (10) 758-759
    CrossrefPubMedGoogle Scholar
  • 35 Traen S, Bochanen N, Ieven M. et al. Is acyclovir effective among critically ill patients with herpes simplex in the respiratory tract?. J Clin Virol 2014; 60 (03) 215-221
    CrossrefPubMedGoogle Scholar
  • 36 Heininger A, Haeberle H, Fischer I. et al. Cytomegalovirus reactivation and associated outcome of critically ill patients with severe sepsis. Crit Care 2011; 15 (02) R77
    CrossrefPubMedGoogle Scholar
  • 37 Detection of herpes viruses by multiplex and real-time polymerase chain reaction in bronchoalveolar lavage fluid of patients with acute lung injury or acute respiratory distress syndrome Tachikaa R, Tomii K, Seo R et al. Respiration 2014; 87 (04) 279-286
    CrossrefPubMedGoogle Scholar