Current practices in the diagnosis and management of HSV and CMV reactivation in German ICUs: an exploratory web-based survey.

Background: Herpes simplex virus (HSV) and cytomegalovirus (CMV) reactivation are increasingly recognized in critically ill patients and may influence clinical outcomes. Diagnostic and therapeutic approaches vary considerably between institutions. We conducted an exploratory web-based survey to assess current practices regarding HSV and CMV reactivation in German intensive care units (ICUs). Methods: Between January 24 and March 5, 2025, 1,642 ICU directors in Germany were invited to complete an online questionnaire comprising 83 items addressing the diagnosis and treatment of HSV and CMV reactivation in critically ill patients, independent of immunosuppressive therapy. Results: The completion rate was 7.5%, with sufficient data for inclusion available from 123 questionnaires, of which 47 were fully completed and 76 were partially completed. Participating hospitals commonly had 501-1,000 beds and ICUs were primarily overseen by anaesthesiology departments with a median capacity of 14 beds. Standard operating procedures for HSV and CMV diagnostics were reported by 33% of institutions for transplant recipients and by 24% for non-immunocompromised ICU patients. According to respondents, virological testing was generally available several times per week, with a median turnaround time of 2 days. Profound heterogeneity in the reported diagnosis and management of HSV and CMV reactivation between surveyed ICUs was observed. Differences encompassed the reported implementation of routine testing, types of specimens and the diagnostic modalities applied, including serological and PCR-based approaches. Routine HSV and CMV testing was more frequently reported in immunosuppressed patients, particularly in solid organ and stem cell transplant recipients. In transplant recipients, PCR-based diagnostics and pre-emptive or prophylactic antiviral strategies were frequently employed, whereas in immunocompetent patients' antiviral therapy was usually initiated only upon clinical suspicion, according to respondents. Conclusion: This exploratory survey among responding ICUs suggests substantial variability in reported diagnostic and therapeutic approaches to HSV and CMV reactivation in German critical care practice. The findings highlight current practice heterogeneity and areas of clinical uncertainty, particularly in critically ill patients without primary immunosuppression.