title: Active cytomegalovirus infection is common in mechanically ventilated medical intensive care unit patients.
abstract: OBJECTIVE
  To assess the incidence, risk factors, and outcome of active cytomegalovirus (CMV) infection in nonimmunosuppressed intensive care unit (ICU) patients.
  
  
  METHODS
  Prospective epidemiologic study.
  
  
  METHODS
  A medical ICU in a university hospital.
  
  
  METHODS
  Two hundred forty-two nonimmunosuppressed ICU patients mechanically ventilated for >or=2 days.
  
  
  METHODS
  Routine pp65 antigenemia and serology for CMV were performed at admission, and then weekly. Bronchoalveolar lavage viral cultures were done when pneumonia was suspected.
  
  
  RESULTS
  Thirty-nine of the 242 ICU patients (16.1%, confidence interval 11.5% to 20.7%) developed an active CMV infection, as diagnosed by positive antigenemia (85%) and/or positive rapid viral culture in bronchoalveolar lavage (26%). Antiviral treatment was initiated in 21 (54%) patients. ICU mortality (54% vs. 37%, p = 0.082) and in-hospital mortality (59% vs. 41%, p = 0.058) were increased in patients with active CMV infection, as compared with those without active CMV infection. Active CMV infection and Simplified Acute Physiology Score II at admission were associated with ICU death on multivariate analysis. The patients with active CMV infection had longer mechanical ventilation and longer ICU stay and were significantly more prone to developing bacterial nosocomial infections (p < 0.001). Logistic regression analysis showed that prior admission to other wards (p = 0.043; odds ratio [OR], 2.49), blood transfusions (p = 0.04; OR, 3.31), enteral feeding (p = 0.005; OR, 3.00), recent corticosteroid use before ICU admission (p = 0.08; OR, 2.26), and age (p = 0.07; OR, 1.026) were associated with the occurrence of active CMV infection.
  
  
  CONCLUSIONS
  : Active CMV infection is common among previously healthy patients under mechanical ventilation in a medical ICU. Further studies are needed to evaluate the role of antiviral treatments to reduce both the incidence and the outcome impact of active CMV infection.
authors.affiliation: Service de Réanimation Médicale, Hôpital Sainte-Marguerite, URMITE UMR-CNRS 6236, Université de la Méditerranée, Marseille, France. laurent.papazian@ap-hm.fr
authors.forename: Laurent
authors.initials: L
authors.lastname: Chiche
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Forel
authors.forename: Antoine
authors.initials: A
authors.lastname: Roch
authors.forename: Christophe
authors.initials: C
authors.lastname: Guervilly
authors.forename: Vanessa
authors.initials: V
authors.lastname: Pauly
authors.forename: Jérôme
authors.initials: J
authors.lastname: Allardet-Servent
authors.forename: Marc
authors.initials: M
authors.lastname: Gainnier
authors.forename: Christine
authors.initials: C
authors.lastname: Zandotti
authors.forename: Laurent
authors.initials: L
authors.lastname: Papazian
mesh_terms: D000368:Aged; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D012307:Risk Factors