title: Is acyclovir effective among critically ill patients with herpes simplex in the respiratory tract?
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Critical Care Medicine, Antwerp University Hospital (UZA), University of Antwerp, Edegem, Belgium.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Traen
authors.affiliation: Department of Critical Care Medicine, Antwerp University Hospital (UZA), University of Antwerp, Edegem, Belgium.
authors.forename: Niels
authors.initials: N
authors.lastname: Bochanen
authors.affiliation: Department of Microbiology, Antwerp University Hospital (UZA), University of Antwerp, Edegem, Belgium.
authors.forename: Margareta
authors.initials: M
authors.lastname: Ieven
authors.affiliation: Department of Critical Care Medicine, Antwerp University Hospital (UZA), University of Antwerp, Edegem, Belgium.
authors.forename: Tom
authors.initials: T
authors.lastname: Schepens
authors.affiliation: Department of Microbiology, Antwerp University Hospital (UZA), University of Antwerp, Edegem, Belgium.
authors.forename: Peggy
authors.initials: P
authors.lastname: Bruynseels
authors.affiliation: Department of Critical Care Medicine, Antwerp University Hospital (UZA), University of Antwerp, Edegem, Belgium.
authors.forename: Walter
authors.initials: W
authors.lastname: Verbrugghe
authors.affiliation: Department of Critical Care Medicine, Antwerp University Hospital (UZA), University of Antwerp, Edegem, Belgium. Electronic address: Philippe.Jorens@uza.be.
authors.forename: Philippe G
authors.initials: PG
authors.lastname: Jorens
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use*; D001992:Bronchoalveolar Lavage Fluid / Q000821:virology; D003422:Critical Care; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D005260:Female; D006561:Herpes Simplex / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D018259:Herpesvirus 1, Human / Q000302:isolation & purification; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000821:virology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D000212:Acyclovir
keywords: Acyclovir; Bronchoalveolar; Critical care; Herpes; Outcome; Respiratory tract