Impact of acyclovir use on survival of patients with ventilator-associated pneumonia and high load herpes simplex virus replication

• Published in: Critical care (London, England) England), 2020-01, Vol.24 (1), p.12-12, Article 12
• Main Authors: Schuierer, Lukas, Gebhard, Michael, Ruf, Hans-Georg, Jaschinski, Ulrich, Berghaus, Thomas M, Wittmann, Michael, Braun, Georg, Busch, Dirk H, Hoffmann, Reinhard
• Format: Article
• Language: English
• Subjects: Acyclovir; Acyclovir - therapeutic use; Aged; Analysis; Antibiotics; Antiviral Agents - therapeutic use; Antiviral drugs; Bronchoalveolar lavage fluid; Care and treatment; Chest x-rays; Cytomegalovirus; Female; Health aspects; Herpes simplex; Herpes simplex virus; Herpes viruses; Herpesvirus infections; Hospital patients; Humans; Information systems; Intensive care; Laboratories; Leukemia; Male; Medical research; Middle Aged; Mortality; Patients; Physiological aspects; Pneumonia; Pneumonia, Ventilator-Associated - epidemiology; Pneumonia, Ventilator-Associated - mortality; Polymerase chain reaction; Radiography - methods; Real-time polymerase chain reaction; Retrospective Studies; Simplexvirus; Simplexvirus - drug effects; Simplexvirus - pathogenicity; Statistics, Nonparametric; Survival Analysis; Testing; Time; Tomography, X-Ray Computed - methods; Ventilator-associated pneumonia; Ventilators; Virus replication; X-rays
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-019-2701-5

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. 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 HSV copies/mL) and low (10 -10 HSV copies/mL) viral load. 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 /FiO ratio increased from 187 to 241 between day 3 and day 7 of treatment (p = 0.02). Chest radiographic findings also improved significantly (p