Cytomegalovirus infection in critically ill patients: a systematic review.
BACKGROUND
The precise role of cytomegalovirus (CMV) infection in contributing to outcomes in critically ill immunocompetent patients has not been fully defined.


METHODS
Studies in which critically ill immunocompetent adults were monitored for CMV infection in the intensive care unit (ICU) were reviewed.


RESULTS
CMV infection occurs in 0 to 36% of critically ill patients, mostly between 4 and 12 days after ICU admission. Potential risk factors for CMV infection include sepsis, requirement of mechanical ventilation, and transfusions. Prolonged mechanical ventilation (21 to 39 days vs. 13 to 24 days) and duration of ICU stay (33 to 69 days vs. 22 to 48 days) correlated significantly with a higher risk of CMV infection. Mortality rates in patients with CMV infection were higher in some but not all studies. Whether CMV produces febrile syndrome or end-organ disease directly in these patients is not known.


CONCLUSIONS
CMV infection frequently occurs in critically ill immunocompetent patients and may be associated with poor outcomes. Further studies are warranted to identify subsets of patients who are likely to develop CMV infection and to determine the impact of antiviral agents on clinically meaningful outcomes in these patients.
Infectious Diseases Section, VA Medical Center, University Drive C, Pittsburgh, PA 15420 USA. osawar@upmc.edu
Ryosuke
R
Osawa
Nina
N
Singh
D000328:Adult; D016638:Critical Illness / Q000453:epidemiology* / Q000401:mortality; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D007121:Immunocompetence; D012307:Risk Factors; D016896:Treatment Outcome; D014775:Virus Activation