PMID- 28158551
OWN - NLM
STAT- MEDLINE
DCOM- 20180102
LR  - 20180308
IS  - 1537-6591 (Electronic)
IS  - 1058-4838 (Linking)
VI  - 64
IP  - 9
DP  - 2017 May 1
TI  - Epidemiology of Multiple Herpes Viremia in Previously Immunocompetent Patients 
      With Septic Shock.
PG  - 1204-1210
LID - 10.1093/cid/cix120 [doi]
AB  - BACKGROUND: Systemic reactivations of herpesviruses may occur in intensive care 
      unit (ICU) patients, even in those without prior immune deficiency. However, the 
      clinical relevance of these events is uncertain. METHODS: In this study we 
      selected patients admitted with septic shock and treated for more than 4 days 
      from a prospectively enrolled cohort of consecutive adults in the mixed ICUs of 2 
      tertiary care hospitals in the Netherlands. We excluded patients who had received 
      antiviral treatment in the week before ICU admission and those with known 
      immunodeficiency. We studied viremia episodes with cytomegalovirus (CMV), 
      Epstein-Barr virus (EBV), human herpesvirus 6 (HHV-6), herpes simplex virus types 
      1 (HSV-1) and 2 (HSV-2), and varicella zoster virus (VZV) by weekly polymerase 
      chain reaction in plasma. RESULTS: Among 329 patients, we observed 399 viremia 
      episodes in 223 (68%) patients. Viremia with CMV, EBV, HHV-6, HSV-1, HSV-2, and 
      VZV was detected in 60 (18%), 157 (48%), 80 (24%), 87 (26%), 13 (4%), and 2 
      (0.6%) patients, respectively; 112 (34%) patients had multiple concurrent viremia 
      events. Crude mortality in the ICU was 36% in this latter group compared to 19% 
      in remaining patients (P < .01). After adjustment for potential confounders, 
      time-dependent bias, and competing risks, only concurrent CMV and EBV 
      reactivations remained independently associated with increased mortality 
      (adjusted subdistribution hazard ratio, 3.17; 95% confidence interval, 
      1.41-7.13). CONCLUSIONS: Herpesvirus reactivations were documented in 68% of 
      septic shock patients without prior immunodeficiency and frequently occurred 
      simultaneously. Concurrent reactivations could be independently associated with 
      mortality. CLINICAL TRIALS REGISTRATION: NCT01905033.
CI  - (c) The Author 2017. Published by Oxford University Press for the Infectious 
      Diseases Society of America. All rights reserved. For permissions, e-mail: 
      journals.permissions@oup.com.
FAU - Ong, David S Y
AU  - Ong DSY
AD  - Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, 
      The Netherlands.
AD  - Department of Intensive Care Medicine, University Medical Center Utrecht, 
      Utrecht, The Netherlands.
FAU - Bonten, Marc J M
AU  - Bonten MJM
AD  - Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, 
      The Netherlands.
AD  - Julius Center for Health Sciences and Primary Care, University Medical Center 
      Utrecht, Utrecht, The Netherlands.
FAU - Spitoni, Cristian
AU  - Spitoni C
AD  - Julius Center for Health Sciences and Primary Care, University Medical Center 
      Utrecht, Utrecht, The Netherlands.
AD  - Department of Mathematics, Utrecht University, The Netherlands.
FAU - Verduyn Lunel, Frans M
AU  - Verduyn Lunel FM
AD  - Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, 
      The Netherlands.
FAU - Frencken, Jos F
AU  - Frencken JF
AD  - Department of Intensive Care Medicine, University Medical Center Utrecht, 
      Utrecht, The Netherlands.
AD  - Julius Center for Health Sciences and Primary Care, University Medical Center 
      Utrecht, Utrecht, The Netherlands.
FAU - Horn, Janneke
AU  - Horn J
AD  - Department of Intensive Care, Academic Medical Center, Amsterdam, The 
      Netherlands.
FAU - Schultz, Marcus J
AU  - Schultz MJ
AD  - Department of Intensive Care, Academic Medical Center, Amsterdam, The 
      Netherlands.
FAU - van der Poll, Tom
AU  - van der Poll T
AD  - Division of Infectious Diseases & Center of Experimental and Molecular Medicine 
      Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
AD  - Center for Infection and Immunity Amsterdam, Academic Medical Center, University 
      of Amsterdam, The Netherlands.
FAU - Klein Klouwenberg, Peter M C
AU  - Klein Klouwenberg PMC
AD  - Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, 
      The Netherlands.
AD  - Department of Intensive Care Medicine, University Medical Center Utrecht, 
      Utrecht, The Netherlands.
FAU - Cremer, Olaf L
AU  - Cremer OL
AD  - Department of Intensive Care Medicine, University Medical Center Utrecht, 
      Utrecht, The Netherlands.
CN  - Molecular Diagnosis and Risk Stratification of Sepsis Consortium
LA  - eng
SI  - ClinicalTrials.gov/NCT01905033
PT  - Journal Article
PL  - United States
TA  - Clin Infect Dis
JT  - Clinical infectious diseases : an official publication of the Infectious Diseases 
      Society of America
JID - 9203213
SB  - IM
MH  - Aged
MH  - Female
MH  - Herpesviridae/classification/*isolation & purification
MH  - Herpesviridae Infections/complications/*epidemiology/virology
MH  - Humans
MH  - Intensive Care Units
MH  - Male
MH  - Middle Aged
MH  - Netherlands
MH  - Prospective Studies
MH  - Shock, Septic/*epidemiology/*etiology
MH  - Tertiary Care Centers
MH  - Viremia/complications/*epidemiology/virology
OTO - NOTNLM
OT  - Epstein-Barr virus
OT  - cytomegalovirus
OT  - human herpesvirus 6
OT  - reactivation
OT  - mortality
EDAT- 2017/02/06 06:00
MHDA- 2018/01/03 06:00
CRDT- 2017/02/04 06:00
PHST- 2016/10/01 00:00 [received]
PHST- 2017/02/01 00:00 [accepted]
PHST- 2017/02/06 06:00 [pubmed]
PHST- 2018/01/03 06:00 [medline]
PHST- 2017/02/04 06:00 [entrez]
AID - 2967978 [pii]
AID - 10.1093/cid/cix120 [doi]
PST - ppublish
SO  - Clin Infect Dis. 2017 May 1;64(9):1204-1210. doi: 10.1093/cid/cix120.