[Chest最新论文]:伴随急性呼吸功能衰竭的病毒肺炎 | 中国病理生理学会危重病医学专业委员会
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2018年07月19日 时讯速递, 进展交流 暂无评论

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

Andrew F. Shorr, Kristen Fisher, Scott T. Micek, et al

Chest 2018; 154: 84-90

Background 背景

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.


Methods 方法

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.


Results 结果

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。

Conclusions 结论

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.



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