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

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??g/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?

SUBMITTER: Schuierer L 

PROVIDER: S-EPMC6954562 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature