Table 1.
Incidence, mortality and morbidity associated with HSV infection in non-immunocompromised ICU patients.
| Year/Reference | Study design | Inclusion criteria | Number of patients | HSV Detection method | Incidence of HSV reactivation | Mortality HSV +/HSV − (%) | Morbidity endpoints assessed |
|---|---|---|---|---|---|---|---|
| 1987 (Tuxen et al., 1987) | Double blind RCT | ARDS | 45 | Culture on respiratory secretions | 6% acyclovir 71% controla |
47 acyclovir 43 control |
DMV |
| 2003 (Bruynseels et al., 2003) | Prospective | Medico-surgical | 764 | Culture on throat or respiratory samples | 22% throat 16% respiratory samples |
33 vs.23b | ICU-LOSb/DMVb |
| 2003 (Cook et al., 2003) | Prospective | Surgical | 95 | Culture in blood and respiratory samples | 23% | 27 vs. 26 | ICU-LOS/DMV |
| 2004 (Ong et al., 2004) | Prospective | Medico-surgical under MV | 393 | PCR on respiratory samples | 27% | 41 vs. 24b | NA |
| 2007 (Engelmann et al., 2007) | Retrospective | Medico-surgical > 3 days ICU stay |
53 | Culture, PCR and indirect immunofluorescence on respiratory samples | 13% | 100 vs. 18b | DMVb |
| 2007 (Luyt et al., 2007) | Prospective | Medical MV > 5 days | 201 | Culture and PCR on respiratory samples | 54% | 48 vs. 42 | ICU-LOSb/DMVb/NIb |
| 2008 (Linssen et al., 2008) | Retrospective | VAP suspicion | 260 | PCR on BAL | 31% | 41 vs. 20b | NI |
| 2009 (De Vos et al., 2009) | Prospective | MV > 2 days | 105 | PCR on respiratory samples | 62% | 35 vs. 48 | DMVb/NIb |
| 2010 (Scheithauer et al., 2010) | Prospective, case control | Suspicion of pneumonia | 103 | PCR on respiratory samples | NA | 45 vs. 35 | ICU-LOSb/DMVb/NIb |
| 2010 (Smith et al., 2010) | Prospective | Patients under MV | 174 | PCR on respiratory samples | 66% | 33 vs. 32b | NA |
| 2011 (Bouza et al., 2011) | Prospective | VAP | 177 | Culture on respiratory samples | 13% | 77 vs. 57 | ICU-LOSb/DMVb/NIb |
| 2012 (Coisel et al., 2012) | Prospective | Pneumonia | 93 | PCR on BAL or IgM + | 24% | 42 vs. 20 | ICU-LOS/DMV/NI |
| 2012 (Costa et al., 2012) | Prospective | VAP suspicion | 237 | PCR on respiratory samples | 32% | 51 vs. 27b | MVb/ICU admissionb/Co-infectionb |
| 2019 (Hraiech et al., 2019) | Retrospective | Severe ARDS with VV ECMO > 2 days | 123 | PCR on throat or BAL | 49% | 48 vs. 59 | ICU-LOSb/DMVb/ECMODb |
| 2019 (Luyt et al., 2019) | Double blind RCT | MV > 96H, HSV reactivation | 239 | PCR on oropharyngeal swab | NA | 22 acyclovir vs. 33 placebo | ICU-LOS/DMV/NI |
| 2020 (Schuierer et al., 2020) | Retrospective | VAP not responding to antibiotics | 425 | PCR on respiratory samples | 30% | HR of death = 0.31, 95% (CI 0.11–0.92, P = .03) in high load patients with acyclovir treatment as compared with no treatment | Improved PaO2/FiO2, decreased norepinephrine doses over time in acyclovir treated patients with high load reactivationb |
BAL, broncho-alveolar lavage; DMV, duration of mechanical ventilation; ECMO, extracorporeal membrane oxygenation; ECMOD, ECMO duration; HR, hazard ratio; HSV, Herpes Simplex Virus; ICU-LOS, intensive care unit length of stay; NA, not available; NI, nosocomial infections; RCT, randomized controlled trial.
a
P < .05 between acyclovir treated patients and controls.
b
P < .05 between HSV positive and HSV negative patients.