title: Cytomegalovirus reactivation in ICU patients.
abstract: BACKGROUND
  Approximately 20 years have passed since we reported our results of histologically proven cytomegalovirus (CMV) pneumonia in non-immunocompromised ICU patients. Even if there are more recent reports suggesting that CMV may worsen the outcomes for ICU patients, there is no definite answer to this question: is CMV a potential pathogen for ICU patients or is it simply a bystander?
  
  
  METHODS
  We will describe the pathophysiology of active CMV infection and the most recent insights concerning the epidemiological aspects of these reactivations.
  
  
  RESULTS
  Cytomegalovirus can be pathogenic by a direct organ insult (such as for the lung), by decreasing host defences against other microorganisms and/or by enhancing the body's inflammatory response (as in acute respiratory distress syndrome). The incidence of active CMV infection is dependent on the diagnostic method used. Using the most sophisticated available biological tools, the incidence can reach 15-20% of ICU patients (20-40% in ICU patients with positive CMV serology). In adequately powered cohorts of patients, active CMV infection appears to be associated with worse outcomes for mechanically ventilated ICU patients.
  
  
  CONCLUSIONS
  There is no absolute direct proof of a negative impact of active CMV infection on the health outcomes of mechanically ventilated patients. Prospective randomized trials are lacking. Future trials should examine the potential benefits for health outcomes of using antiviral treatments. Such treatments could be prophylactic, pre-emptive or used only when there is an end-organ disease.
  
  
  CONCLUSIONS
  Cytomegalovirus infection may affect health outcomes for ICU patients. Additional prospective trials are necessary to confirm this hypothesis.
authors.affiliation: Faculté de Médecine, Aix-Marseille Université, URMITE UMR CNRS 7278, 13005, Marseille, France. laurent.papazian@ap-hm.fr.|Réanimation des Détresses Respiratoires et des Infections Sévères, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Chemin des Bourrely, 13015, Marseille, France. laurent.papazian@ap-hm.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Papazian
authors.affiliation: Faculté de Médecine, Aix-Marseille Université, URMITE UMR CNRS 7278, 13005, Marseille, France.|Réanimation des Détresses Respiratoires et des Infections Sévères, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Chemin des Bourrely, 13015, Marseille, France.
authors.forename: Sami
authors.initials: S
authors.lastname: Hraiech
authors.affiliation: Faculté de Médecine, Aix-Marseille Université, URMITE UMR CNRS 7278, 13005, Marseille, France.|Réanimation des Détresses Respiratoires et des Infections Sévères, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Chemin des Bourrely, 13015, Marseille, France.
authors.forename: Samuel
authors.initials: S
authors.lastname: Lehingue
authors.affiliation: Faculté de Médecine, Aix-Marseille Université, URMITE UMR CNRS 7278, 13005, Marseille, France.|Service d'accueil des Urgences, Assistance Publique-Hôpitaux de Marseille, Nord, 13015, Marseille, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Roch
authors.affiliation: Département de Médecine Interne, Hôpital Européen, 13003, Marseille, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Chiche
authors.affiliation: Service d'Anesthésie-Réanimation, Assistance Publique-Hôpitaux de Marseille, Hôpital de la Conception, 13005, Marseille, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Wiramus
authors.affiliation: Faculté de Médecine, Aix-Marseille Université, URMITE UMR CNRS 7278, 13005, Marseille, France.|Réanimation des Détresses Respiratoires et des Infections Sévères, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Chemin des Bourrely, 13015, Marseille, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Forel
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D018890:Chemoprevention / Q000379:methods; D016638:Critical Illness; D003587:Cytomegalovirus / Q000276:immunology / Q000302:isolation & purification / Q000472:pathogenicity*; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control; D006801:Humans; D007121:Immunocompetence; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008828:Microbiological Techniques / Q000379:methods / Q000592:standards; D011024:Pneumonia, Viral / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control; D012121:Respiration, Artificial / Q000009:adverse effects; D018570:Risk Assessment; D016036:Seroepidemiologic Studies
chemical_list: D000998:Antiviral Agents
keywords: Cytomegalovirus; ICU; Incidence; Mechanical ventilation; Mortality; Reactivation