Clinical significance of a positive serology for mimivirus in patients presenting a suspicion of ventilator-associated pneumonia.

Vincent, Agnès; La Scola, Bernard; Forel, Jean-Marie; Pauly, Vanessa; Raoult, Didier; Papazian, Laurent

OBJECTIVE A seroconversion to mimivirus has been observed in patients with community-acquired or nosocomial pneumonia. The aim of this study was to determine whether a positive serology for mimivirus was associated with increased morbidity and mortality in patients with a suspicion of ventilator-associated pneumonia (VAP). DESIGN Prospective matched-cohort study. SETTING A 12-bed medical intensive care unit (ICU) in a teaching hospital. PATIENTS Patients ventilated for at least 2 days presenting with a suspicion of VAP. Patients with a positive serology for mimivirus were matched to seronegative patients. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Matching criteria were: 1) the same main diagnosis on ICU admission, 2) the same age (+/- 10 yrs), 3) the same Simplified Acute Physiology II score (+/-10 points), 4) the same McCabe and Jackson comorbidity score, 5) admission within 1 year, and 6) diagnosis of at least one bacterial VAP during the ICU stay or not. A total of 55 pairs were submitted for analysis. The effectiveness of matching was 94.8%. Patients with a positive serology for mimivirus had longer duration of mechanical ventilation and ICU stay with median excesses of 7 days and 10 days, respectively. There was no difference in ICU mortality. The duration of mechanical ventilation before bronchoalveolar lavage (adjusted odds ratios [OR]1.08, p = 0.02), viral identification other than mimivirus during ICU stay (adjusted OR 0.32, p = 0.05), and enteral nutrition (adjusted OR 0.13, p = 0.01) were associated with positive serology for mimivirus. CONCLUSION A positive serology for mimivirus is associated with a poorer outcome in mechanically ventilated ICU patients.