2007 OPEN FORUM Abstracts
CLINICAL PROFILES AND OUTCOMES OF ICU PATIENTS WITH HERPES SIMPLEX IN RESPIRATORY SECRETIONS
K. M. Sundar1, K. A. Ludwig1, W. T. Alward1
Background: Herpes simplex virus (HSV) infections have beenreported in patients with immunosuppression, severe burns and malignancies. HSV infections have been recognized increasingly in critically ill patients in whome they have been reported to predisose to secondary bacterial infections and associated with worse outcomes. Theis retrospective analysisi was conducted to delineate clinical features that would help identify ICU patients with HSV infections early and assess the impact of specific treatment directed at HSV on their outcome.
Method: Clinical characteristics and outcomes of 11 ICU patients with findings of a positive HSV detected by polymerase chain reaction (PCR) in respiratory secretions (sputum, tracheal aspirate, or bronchoalvelar lavage) were studied.
Results: All patients received invasive ventilatory support for prolonged peiods (mean of 30.5 days; range 5-85 days), were elderly (mean 66 yrs; range 44-83 yrs.), and had no prior documentation of herpetic infections. Only one patient was immunosuppressed. All but one patient had ventilator-associated pneumonia. Concomitant herpetic orofacial infection was found in 2/11 patients. Complicating bacterial infections occurred in 10/11 patients (4/10 gram-positive, 3/10 gram-negative, and 3/10 both). All patients were treated with Acyclovir in addition to specific therapy for bacterial pneumonia. 5/11 patients died, tracheostomy was required due to prolonged weaning on 4/11 patients. Findings of tracheobronchitis on bronchoscopy were found in 3/11 patients. Herpetic facial lesions, post-extubation stridor and hemorrhagic secretions were felt to be associated with the finding of HSV in respiratory secretions.
Conclusion: The finding of HSV in respiratory secretions of ICU patients is associated with concomitant bacterial infections, prolonged ventilator stays and poor outcomes despite specific therapy directed at HSV infections.