Stephanie Traen1, Niels Bochanen1, Margareta Ieven2, Tom Schepens1, Peggy Bruynseels2, Walter Verbrugghe1, Philippe G Jorens3. 1. Department of Critical Care Medicine, Antwerp University Hospital (UZA), University of Antwerp, Edegem, Belgium. 2. Department of Microbiology, Antwerp University Hospital (UZA), University of Antwerp, Edegem, Belgium. 3. Department of Critical Care Medicine, Antwerp University Hospital (UZA), University of Antwerp, Edegem, Belgium. Electronic address: Philippe.Jorens@uza.be.
Abstract
BACKGROUND AND OBJECTIVE: The relevance of the detection of herpes simplex virus type 1 (HSV-1) in the respiratory tract of patients in the intensive care unit (ICU) is unclear. Therefore, it is uncertain whether treatment with an antiviral agent could be beneficial for these patients. STUDY DESIGN: We retrospectively reviewed the records of ICU patients with a positive HSV-1 culture in the respiratory tract or bronchoalveolar lavage (BAL) fluid. We evaluated whether acyclovir treatment (n=106) could have a beneficial effect on mortality as compared with the standard treatment (n=106). RESULTS: Acyclovir treatment was positively linked to in-hospital and ICU-mortality reduction. This favourable influence remained present after correcting for possible confounders and using propensity-adjusted and propensity-matched cohorts: with an odds ratio in the treated group of 3.19 (95% CI 1.79-5.69, p=0.001) for ICU survival and of 3.55 (95% CI 2.16-5.85, p<0.001) for in-hospital survival. The subgroup with HSV-1 detected in the BAL-fluid is the sole contributor to this difference. In the BAL-fluid detected group, 48% (n=10) of non-treated patients died in the ICU, versus 21% (n=6) in the acyclovir-treated group (p=0.033), occurring despite an even longer duration of ventilation or ICU stay. CONCLUSIONS: These data highlight the hypothesis that it might be worthwhile to consider treatment of HSV-1 in ICU patients depending on the type of respiratory sample in which the virus is detected. These results warrant a prospective trial to prove causality.
BACKGROUND AND OBJECTIVE: The relevance of the detection of herpes simplex virus type 1 (HSV-1) in the respiratory tract of patients in the intensive care unit (ICU) is unclear. Therefore, it is uncertain whether treatment with an antiviral agent could be beneficial for these patients. STUDY DESIGN: We retrospectively reviewed the records of ICU patients with a positive HSV-1 culture in the respiratory tract or bronchoalveolar lavage (BAL) fluid. We evaluated whether acyclovir treatment (n=106) could have a beneficial effect on mortality as compared with the standard treatment (n=106). RESULTS:Acyclovir treatment was positively linked to in-hospital and ICU-mortality reduction. This favourable influence remained present after correcting for possible confounders and using propensity-adjusted and propensity-matched cohorts: with an odds ratio in the treated group of 3.19 (95% CI 1.79-5.69, p=0.001) for ICU survival and of 3.55 (95% CI 2.16-5.85, p<0.001) for in-hospital survival. The subgroup with HSV-1 detected in the BAL-fluid is the sole contributor to this difference. In the BAL-fluid detected group, 48% (n=10) of non-treated patients died in the ICU, versus 21% (n=6) in the acyclovir-treated group (p=0.033), occurring despite an even longer duration of ventilation or ICU stay. CONCLUSIONS: These data highlight the hypothesis that it might be worthwhile to consider treatment of HSV-1 in ICUpatients depending on the type of respiratory sample in which the virus is detected. These results warrant a prospective trial to prove causality.
Authors: Paul Wurzer; Megan R Cole; Robert P Clayton; Gabriel Hundeshagen; Omar Nunez Lopez; Janos Cambiaso-Daniel; Raimund Winter; Ludwik K Branski; Hal K Hawkins; Celeste C Finnerty; David N Herndon; Jong O Lee Journal: Burns Date: 2017-04-15 Impact factor: 2.744
Authors: Sami Hraiech; Eline Bonnardel; Christophe Guervilly; Cyprien Fabre; Anderson Loundou; Jean-Marie Forel; Mélanie Adda; Gabriel Parzy; Guilhem Cavaille; Benjamin Coiffard; Antoine Roch; Laurent Papazian Journal: Ann Intensive Care Date: 2019-12-23 Impact factor: 6.925