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Clinical Investigations in Critical Care |

Cytomegalovirus Infection in Critically Ill Patients*: Associated Factors and Consequences

Samir Jaber, MD, PhD; Gérald Chanques, MD; Jean Borry, MD; Bruno Souche, MD; Régis Verdier, MD; Pierre-François Perrigault, MD; Jean-Jacques Eledjam, MD, PhD
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*From the Intensive Care Unit and Transplantation Department (Drs. Jaber, Chanques, Borry, Souche, Perrigault, and Eledjam), Saint Eloi Hospital, University Hospital of Montpellier; and Department of Biostatistics (Dr. Verdier), Arnaud de Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France.

Correspondence to: Samir Jaber, MD, PhD, Unité de Réanimation-Département d’Anesthésie-Réanimation “B”, University Hospital, Chu de Montpellier Hopital Saint Eloi 80, Ave Augustin Fliche, 34295 Montpellier Cedex 5, France; e-mail: s-jaber@chu-montpellier.fr



Chest. 2005;127(1):233-241. doi:10.1378/chest.127.1.233
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Objective: To determine the prevalence, associated findings, and consequences of cytomegalovirus (CMV) antigenemia in critically ill patients.

Design: A retrospective, case-control clinical study.

Setting: A 12-bed university hospital medical-surgical ICU.

Patients: 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.

Interventions: None.

Measurements and 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.

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