Heimes Elisabeth, Baier Michael, Forstner Christina, Weis Sebastian, Bauer Michael, Fritzenwanger Michael, Scherag André, Pletz Mathias W, Kesselmeier Miriam, Hagel Stefan
Institutes for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany.
Medical Microbiology, Jena University Hospital, Jena, Germany.
Chest. 2020 Nov;158(5):1867-1875. doi: 10.1016/j.chest.2020.06.056. Epub 2020 Jul 3.
Herpes simplex virus type 1 (HSV-1) is frequently detected in the BAL fluid of patients on mechanical ventilation.
The aim of the study was to investigate whether antiviral therapy is associated with improved overall survival within 30 days.
This 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.
Overall, 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.
These 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.
在接受机械通气的患者的支气管肺泡灌洗（BAL）液中经常检测到1型单纯疱疹病毒（HSV-1）。
本研究的目的是调查抗病毒治疗是否与30天内总体生存率的提高相关。
这是一项2011年1月至2017年12月期间在四个重症监护病房（ICU）进行的回顾性队列研究。纳入所有接受机械通气且呼吸道感染、BAL中聚合酶链反应检测HSV-1呈阳性的成年患者。在进行BAL当天已接受抗病毒药物治疗的患者被排除。我们进行了单变量和多变量Cox回归及逻辑回归建模。
总体而言，306例患者纳入分析。其中，177例患者（57.8%）接受了抗病毒治疗（90.9%为阿昔洛韦，6.2%为更昔洛韦，2.9%两者均用）。抗病毒治疗组的30天总体死亡率为42.4%（n = 75），对照组为50.4%（n = 65）。主要结局的校正风险比（HR）为0.62（95%可信区间[CI]，0.44 - 0.87；P = 0.005），表明抗病毒治疗组在30天内的总体生存率优于未治疗组。这种益处也存在于无免疫抑制的患者亚组中（n = 246；校正HR，0.53；95%CI，0.36 - 0.78；P = 0.001）。总体而言，接受治疗的患者住院时间中位数（31天对24天，P = 0.002）、ICU住院时间中位数（24天对17天，P < 0.001）和机械通气时间（18天对11天，P < 0.001）更长。未观察到与治疗相关的肾功能恶化证据。
这些数据表明，在接受机械通气的患者BAL中检测到HSV-1可能具有临床意义，特定的抗病毒治疗可能改善临床结局。然而，在应用于临床常规之前，这需要在多中心随机对照试验中得到证实。
