The Burden of Viruses in Pneumonia Associated With Acute Respiratory Failure: An Underappreciated Issue

Pneumonia associated with mechanical ventilation (MV) results in substantial mortality and represents a leading reason for the use of antibiotics. The role of viruses in this setting is unclear. Identifying a viral cause in such instances could facilitate antibiotic stewardship.

需要机械通气(MV)的肺炎患者病死率很高，同时也是导致抗生素使用的首要原因。在这种情况下病毒的作用并不清楚。确诊病毒感染可能有助于抗生素的合理使用。

We performed a secondary analysis of a prospective cohort with pneumonia requiring MV. We included both cases occurring in the community and hospital-onset cases and classified patients according to the cause of the pneumonia. The prevalence of viral pathogens represented the primary end point. We identified variables independently associated with isolation of a viral organism as the sole pathogen.

我们对需要MV的肺炎患者的一个前瞻队列研究数据进行了二次分析。我们纳入了社区及医院获得性肺炎病例，并将患者根据病因分组。病毒感染患病率为主要预后终点。我们对单纯病毒感染的独立相关因素进行了分析。

The cohort included 364 patients, and a virus was the sole pathogen in 79 cases (21.7%). The most common viruses included rhinovirus/enterovirus (n = 20), influenza A (n = 12), and respiratory syncytial virus (n = 11). The rate of in-hospital death was high (37.2%) and did not differ from that seen in other patients (36.5%). The duration of MV, hospital length of stay, and 30-day readmission rates also did not differ based on the cause of pneumonia. Two variables were independently associated with recovery of a virus: an Acute Physiology and Health Evaluation II score of < 26 (adjusted odds ratio [AOR], 0.51; 95% CI, 0.28-0.93; P = .027) and stem cell transplantation (SCT) (AOR, 4.39; 95% CI, 2.03-9.50; P = .001). A sensitivity analysis excluding patients who underwent SCT did not substantially alter our observations.

队列纳入了364名患者，其中79名(21.7%)患者为单纯病毒感染。最常见的病毒为鼻病毒/肠道病毒(n = 20)，甲型流感病毒(n = 12)，及呼吸道合胞病毒(n = 11)。住院病死率很高(37.2%)且与其他患者无显著差异(36.5%)。不同病因的肺炎患者MV时间、住院日及30天再入院比例并无差异。2项指标与病毒感染独立相关：APACHE评分 < 26（校正比数比[AOR], 0.51; 95% CI, 0.28-0.93; P = .027）及干细胞移植(SCT) (AOR, 4.39; 95% CI, 2.03-9.50; P = .001)。排除SCT患者后进行的敏感性分析并不改变研究结果。

Viruses represent a major cause of pneumonia in critically ill patients requiring MV. Identifying such subjects presents an opportunity for discontinuing antibiotics. Clinicians should consider systematically evaluating patients with pneumonia requiring MV for viral pathogens.

病毒是接受MV的危重病肺炎患者的重要病因。鉴别病毒肺炎患者有助于停用抗生素。临床医生对需要MV的病毒肺炎患者应当进行系统评估。