OCCULT HERPES FAMILY VIRUSES MAY INCREASE MORTALITY IN CRITICALLY ILLSURGICAL PATIENTS

BACKGROUND: Effects of cytomegalovirus (CMV) or herpes simplex virus ( HSV) infection on surgical intensive care unit (SICU) patients' hospit al outcome are unknown. METHODS: Between July 1, 1994, and September 1 , 1995, general SICU patients with persistent sepsis and no bacterial or fungal source identifiable had viral cultures obtained. Patients wi th positive broncho-alveolar lavage, blood, skin, or sputum cultures f or CMV or HSV were studied. RESULTS: Twenty eligible patients had posi tive viral cultures during the study period, and 85% of these patients developed subsequent bacterial and/or fungal infections. Mortality wa s significantly higher following viral infection than in chronic SICU patients (65% vs 35%, P <0.006). Patients with thrombocytopenia compli cating their viral infection had significantly higher mortality than t hose without thrombocytopenia (92% vs 25%, P <0.004). CONCLUSIONS: At least 14% of critically ill surgical patients have occult infection or reactivation of herpes family viruses. These viruses have known immun osuppressive effects, which may predispose chronic SICU patients to su bsequent bacterial and fungal infection, and subsequent organ system f ailure and death. (C) 1998 by Excerpta Medica, Inc.