Article ; Online: Impact of acyclovir use on survival of patients with ventilator-associated pneumonia and high load herpes simplex virus replication.
Critical care (London, England)
2020 Volume 24, Issue 1, Page(s) 12
Abstract: Background: Herpes simplex virus (HSV) replication can be detected in the respiratory secretions of a high proportion of ventilated intensive care unit (ICU) patients. However, the clinical significance remains poorly defined. We investigated whether ... ...
| Abstract | Background: Herpes simplex virus (HSV) replication can be detected in the respiratory secretions of a high proportion of ventilated intensive care unit (ICU) patients. However, the clinical significance remains poorly defined. We investigated whether patients with ventilator-associated pneumonia not responding to antibiotics and in whom high levels of HSV could be detected in respiratory secretions benefit from acyclovir treatment. Methods: Respiratory secretions (bronchoalveolar lavage fluid or tracheal aspirates) were tested for HSV replication by quantitative real-time PCR. ICU survival times, clinical parameters, and radiographic findings were retrospectively compared between untreated and acyclovir treated patients with high (> 10 Results: Fifty-seven low and 69 high viral load patients were identified. Fewer patients with high viral load responded to antibiotic treatment (12% compared to 40% of low load patients, p = 0.001). Acyclovir improved median ICU survival (8 vs 22 days, p = 0.014) and was associated with a significantly reduced hazard ratio for ICU death (HR = 0.31, 95% CI 0.11-0.92, p = 0.035) in high load patients only. Moreover, circulatory and pulmonary oxygenation function of high load patients improved significantly over the course of acyclovir treatment: mean norepinephrine doses decreased from 0.05 to 0.02 μg/kg body weight/min between days 0 and 6 of treatment (p = 0.049), and median PaO Conclusions: In patients with ventilator-associated pneumonia, antibiotic treatment failure, and high levels of HSV replication, acyclovir treatment was associated with a significantly longer time to death in the ICU and improved circulatory and pulmonary function. This suggests a causative role for HSV in this highly selected group of patients. |
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| MeSH term(s) | Acyclovir/therapeutic use ; Aged ; Antiviral Agents/therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Pneumonia, Ventilator-Associated/epidemiology ; Pneumonia, Ventilator-Associated/mortality ; Radiography/methods ; Retrospective Studies ; Simplexvirus/drug effects ; Simplexvirus/pathogenicity ; Statistics, Nonparametric ; Survival Analysis ; Tomography, X-Ray Computed/methods |
| Chemical Substances | Antiviral Agents ; Acyclovir (X4HES1O11F) |
| Keywords | covid19 |
| Language | English |
| Publishing date | 2020-01-10 |
| Publishing country | England |
| Document type | Journal Article |
| ZDB-ID | 2041406-7 |
| ISSN | 1466-609X ; 1364-8535 |
| ISSN (online) | 1466-609X |
| ISSN | 1364-8535 |
| DOI | 10.1186/s13054-019-2701-5 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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