Luyt Charles-Edouard, Hékimian Guillaume, Bréchot Nicolas, Chastre Jean
Service de Médecine Intensive Réanimation, Sorbonne Université, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris.
INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris.
Semin Respir Crit Care Med. 2022 Apr;43(2):310-318. doi: 10.1055/s-0041-1740981. Epub 2022 Jan 31.
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.
在可能导致医院获得性肺炎和呼吸机相关性肺炎的病毒中，单纯疱疹病毒（HSV）可能是最常涉及的：HSV再激活在重症监护病房患者中很常见，并且肺实质感染（HSV支气管肺炎）已有充分描述，可通过支气管肺泡灌洗获得的细胞中实质受累的细胞学体征或通过下呼吸道的HSV病毒载量来诊断。尽管基于专家意见可能建议治疗HSV支气管肺炎患者，但应避免对HSV再激活进行预防性或抢先性治疗。由巨细胞病毒（CMV）引起的呼吸机相关性肺炎比HSV支气管肺炎少见，且更难诊断。关于抗病毒治疗对CMV肺炎的影响尚无数据。呼吸道病毒与医疗保健相关肺炎和医院获得性肺炎患者的感染有关，但其在呼吸机相关性肺炎中的作用尚不清楚。
