title: Herpes simplex activation prolongs recovery from severe burn injury and increases bacterial infection risk.
abstract: Recovery from severe burn injury is complicated by infections that are result of immune suppression created by massive inflammatory states. One indication of immune suppression may be activation of viruses like herpes simplex virus (HSV), which may negatively impact recovery. A 5-year retrospective review was performed of adult patients with ≥30% TBSA burn injury. TBSA burn injury, length of hospital stay, ventilator days, mortality, and cultures were reviewed. Twenty-one patients had cutaneous HSV activation (HSV+) and 50 did not (HSV-). Age (44.2 vs 39.8 years) and TBSA burn injury (45.9 vs 45.5%) did not differ between the groups. Length of hospital stay (60.9 vs 39.8 days, P < .05) and ventilator days (34.9 vs 22.2 days, P < .05) were greater in HSV+ patients. HSV activation increased hospital stay (odds ratio [OR] 1.6, confidence interval [CI] 1.08-2.39, P < .05) and mechanical ventilation (OR 1.02, CI 1.00-1.05, P < .05). HSV activation increased the risk of developing positive Acinetobacter baumannii pulmonary cultures (OR 6.4, CI 1.8-22.3, P < .05) and methicillin-resistant Staphylococcus aureus wound cultures (OR 3.3, CI 1.2-9.6, P < .05). HSV activation also increased the risk of developing any positive A. baumannii cultures (OR 9.1, CI 1.9-44, P < .05). HSV activation during severe burn injury is associated with increased length of mechanical ventilation and hospital stay. In addition, these patients have an increased risk of infections from opportunistic bacteria.
authors.affiliation: Department of Surgery, University of California Davis, Sacramento, CA, USA.
authors.forename: Soman
authors.initials: S
authors.lastname: Sen
authors.forename: Nova
authors.initials: N
authors.lastname: Szoka
authors.forename: Ho
authors.initials: H
authors.lastname: Phan
authors.forename: Tina
authors.initials: T
authors.lastname: Palmieri
authors.forename: David
authors.initials: D
authors.lastname: Greenhalgh
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001424:Bacterial Infections / Q000453:epidemiology / Q000276:immunology*; D002053:Burn Units; D002056:Burns / Q000453:epidemiology* / Q000276:immunology* / Q000628:therapy; D002140:California; D015331:Cohort Studies; D016001:Confidence Intervals; D003428:Cross Infection / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology; D018450:Disease Progression; D005260:Female; D006561:Herpes Simplex / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate