• Elisabeth Heimes, Michael Baier, Christina Forstner, Sebastian Weis, Michael Bauer, Michael Fritzenwanger, André Scherag, Mathias W Pletz, Miriam Kesselmeier, and Stefan Hagel.
• Institutes for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany.
• Chest. 2020 Nov 1; 158 (5): 1867-1875.

BackgroundHerpes simplex virus type 1 (HSV-1) is frequently detected in the BAL fluid of patients on mechanical ventilation.Research QuestionThe aim of the study was to investigate whether antiviral therapy is associated with improved overall survival within 30 days.Study Design And MethodsThis was a retrospective cohort study in four ICUs between January 2011 and December 2017. All adult patients on mechanical ventilation with a respiratory tract infection with positive polymerase chain reaction testing for HSV-1 in the BAL were included. Patients already receiving antiviral agents on the day BAL was performed were excluded. We performed uni- and multivariable Cox and logistic regression modeling.ResultsOverall, 306 patients were included in the analysis. Among them, 177 patients (57.8%) received antiviral therapy (90.9% acyclovir, 6.2% ganciclovir, 2.9% both). The overall 30-day mortality rate was 42.4% (n = 75) in the antiviral treatment group and 50.4% (n = 65) in the control group. The adjusted hazard ratio (HR) for the primary outcome was 0.62 (95% CI, 0.44-0.87; P = .005), indicating better overall survival within 30 days for the antiviral-treated group than for the untreated group. This benefit was also present in the subgroup of patients without immunosuppression (n = 246; adjusted HR, 0.53; 95% CI, 0.36-0.78; P = .001). Overall, the median lengths of hospital stay (31 vs 24 days, P = .002) and ICU stay (24 vs 17 days, P < .001), and the duration of mechanical ventilation (18 vs 11 days, P < .001), were longer for patients with therapy. No evidence for the treatment-related deterioration of renal function was observed.InterpretationThese data suggest that detection of HSV-1 in the BAL of patients on mechanical ventilation may be of clinical significance and that specific antiviral treatment may improve clinical outcomes. However, this needs to be proven in multicenter randomized controlled trials before implementation into the clinical routine.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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