Cytomegalovirus infection in critically ill patients: associated factors and consequences.
OBJECTIVE
To determine the prevalence, associated findings, and consequences of cytomegalovirus (CMV) antigenemia in critically ill patients.


METHODS
A retrospective, case-control clinical study.


METHODS
A 12-bed university hospital medical-surgical ICU.


METHODS
Two hundred thirty-seven patients with fever for > 72 h, without proven evidence of bacteriologic and/or fungal origin, and whose pp65 antigenemia assays were studied. Patients with HIV infection and transplant recipients were excluded.


METHODS
None.


RESULTS
CMV antigenemia was diagnosed within 20 +/- 12 days (mean +/- SD) after ICU admission in 17% patients in whom the pathology was suspected. The 40 patients in the CMV group were matched with 40 other patients in the control group. CMV infection was linked to renal failure (58% vs 33%, respectively; p = 0.02) and steroid use (55% vs 33%, respectively; p = 0.04). Patients with CMV had a significantly longer stay in the ICU (41 +/- 28 days vs 31 +/- 22 days, respectively; p = 0.04), a longer duration of mechanical ventilation (35 +/- 27 days vs 24 +/- 20 days, respectively; p = 0.03), a higher rate of nosocomial infection (75% vs 50%, respectively; p = 0.04), and a higher mortality (50% vs 28%, p = 0.02).


CONCLUSIONS
CMV antigenemia is not an uncommon diagnosis in critically ill ICU patients with unexplained prolonged fever after 10 days of hospitalization, regardless of their immune system status. Although associated with a higher morbidity and mortality, the clinical significance of CMV is unknown. Further prospective studies should evaluate the impact on ICU outcome and whether CMV is truly a pathogen or simply another indicator of immunosuppression.
Jaber
Samir
S
Intensive Care Unit and Transplantation Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France. s-jaber@chu-montpellier.fr
Chanques
Gérald
G
Borry
Jean
J
Souche
Bruno
B
Verdier
Régis
R
Perrigault
Pierre-François
PF
Eledjam
Jean-Jacques
JJ
D000328:Adult; D000956:Antigens, Viral / Q000097:blood; D015897:Comorbidity; D016638:Critical Illness / Q000453:epidemiology*; D003587:Cytomegalovirus / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
D000956:Antigens, Viral