title: Cytomegalovirus infection in critically ill patients: associated factors and consequences.
abstract: 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.
authors.affiliation: Intensive Care Unit and Transplantation Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France. s-jaber@chu-montpellier.fr
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
authors.forename: Gérald
authors.initials: G
authors.lastname: Chanques
authors.forename: Jean
authors.initials: J
authors.lastname: Borry
authors.forename: Bruno
authors.initials: B
authors.lastname: Souche
authors.forename: Régis
authors.initials: R
authors.lastname: Verdier
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Perrigault
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Eledjam
mesh_terms: 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
chemical_list: D000956:Antigens, Viral