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- Titel:
Impact of acyclovir use on survival of patients with ventilator-associated pneumonia and high load herpes simplex virus replication.
- Dokumenttyp:
- Article; Journal Article
- Autor(en):
- Schuierer, Lukas; Gebhard, Michael; Ruf, Hans-Georg; Jaschinski, Ulrich; Berghaus, Thomas M; Wittmann, Michael; Braun, Georg; Busch, Dirk H; Hoffmann, Reinhard
- 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 (> 105 HSV copies/mL) and low (103-105 HSV copies/mL) viral load. 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 PaO2/FiO2 ratio increased from 187 to 241 between day 3 and day 7 of treatment (p = 0.02). Chest radiographic findings also improved significantly (p < 0.001). 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.
- Zeitschriftentitel:
- Crit Care
- Jahr:
- 2020
- Band / Volume:
- 24
- Heft / Issue:
- 1
- Volltext / DOI:
- doi:10.1186/s13054-019-2701-5
- PubMed:
- http://view.ncbi.nlm.nih.gov/pubmed/31924246
- Print-ISSN:
- 1466-609X
- TUM Einrichtung:
- Institut für Medizinische Mikrobiologie, Immunologie und Hygiene (Prof. Busch)
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