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Correspondence |

Low Cytomegalovirus Viremia Prevalence in a General Intensive Care Population FREE TO VIEW

Élise Gilbert, MD; Philippe Rico, MD; Pierre J. Laflamme, MD; Martin Albert, MD
Author and Funding Information

From the Intensive Care Department (Drs Gilbert, Rico, and Albert); the Internal Medicine Department (Drs Rico and Albert); and the Infectious Disease Department (Dr Laflamme); Hôpital du Sacré-Coeur de Montréal Research Centre; Université de Montréal.

Correspondence to: Martin Albert, MD, Intensive Care Department and Internal Medicine Department, Hôpital du Sacré-Coeur de Montréal Research Center, Université de Montréal, 5400, boul. Gouin Ouest, Montréal, QC H4J 1C5, Canada; e-mail: m.albert@umontreal.ca


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Funding/Support: This work was supported by the Équipe de Recherche en Soins Intensifs (ERESI) de l’hôpital du Sacré-Cœur de Montréal Research Fund. The CMV PCR assay was supported by Hoffmann-La Roche Ltd.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(2):478-479. doi:10.1378/chest.10-2290
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The prevalence and the clinical significance of the cytomegalovirus (CMV) infection in the immunocompetent ICU patient remain unclear. Conflicting results have been obtained from recent studies.1-6 The aim of our study was to determine the prevalence and the clinical significance of CMV viremia in a general population of immunocompetent adult critical care patients.

This observational study was conducted in our 24-bed, academic medical-surgical ICU from May 2005 to December 2007. The research protocol was approved by the Institutional Ethics Committee. All consecutive nonimmunosuppressed patients with an ICU length of stay >5 days were screened. After 50 patients were seen, inclusion criteria were changed to 10 days after observation of a very low prevalence of CMV viremia. Informed consent was obtained from each patient. Blood samples for CMV serology (IgG and IgM enzyme-linked immunosorbent assay) (Zeus Scientific; Raritan, New Jersey) and serum CMV-polymerase chain reaction (PCR) (Cobas Amplicor CMV Monitor; Roche Inc; Basel, Switzerland) were collected at study admission and weekly thereafter until the patient was discharged to the ward or for a maximum of 1 month of ICU stay.

The patients’ characteristics are shown in Table 1. Overall, 51% of the patients had a positive serology result for CMV-IgG and 3% for CMV-IgM. Only one patient had a positive PCR analysis after 28 days of ICU stay in the medical unit. No obvious unexplained clinical manifestations potentially related to CMV were detected in the complete cohorts.

Table Graphic Jump Location
Table 1 —Patient Characteristics

Data are presented as mean ±  SD or No. (%). Group A: baseline 5 d of ICU admission; Group B: baseline 10 d of ICU admission. APACHE = Acute Physiology and Chronic Health Evaluation.

Our study demonstrates a very low prevalence of CMV viremia in a nonimmunocompromised general ICU population even with prolonged length of stay, with only one positive CMV-PCR result detected in the complete cohort. Recently, a systematic review identified a total of 13 studies that have described CMV infection in immunocompetent critically ill patients.7 CMV infection occurred in 0% to 36% of these critically ill patients. The authors found considerable heterogeneity in the methodology used to assess CMV infection and in the study population, which can explain the variability of the results. Our study has some limitations, including relatively low Acute Physiology and Chronic Health Evaluation (APACHE) II scores for each group, despite a relatively long length of stay in the ICU.

In conclusion, despite the use of a very sensitive PCR assay, we were unable to demonstrate a significant prevalence of CMV viremia in our nonimmunocompromised ICU population. Accordingly, our data do not support empiric screening of nonimmunocompromised ICU patients in the absence of clinical evidence of CMV infection.

Author contributions: Dr Albert had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Gilbert: contributed to the study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, and critical revision of the manuscript for important intellectual content.

Dr Rico: contributed to the study concept and design, analysis and interpretation of data, and critical revision of the manuscript for important intellectual content.

Dr Laflamme: contributed to the study concept and design, analysis and interpretation of data, and critical revision of the manuscript for important intellectual content.

Dr Albert: contributed to the study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, and critical revision of the manuscript for important intellectual content.

Role of Sponsors: The CMV-PCR assays were graciously provided by Roche Inc, which had no role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, or in the preparation, review, or approval of the manuscript.

Ljungman P, Einsele H. Cytomegalovirus infection. Curr Opin Hematol. 1994;16:418-422. [PubMed]
 
Marik PE, Weinmann A. Cytomegalovirus in “immunocompetent,” critically ill, intensive care patients. Crit Care Med. 2001;293:681-682. [CrossRef] [PubMed]
 
Kutza AS, Muhl E, Hackstein H, Kirchner H, Bein G. High incidence of active cytomegalovirus infection among septic patients. Clin Infect Dis. 1998;265:1076-1082. [CrossRef] [PubMed]
 
Limaye AP, Kirby KA, Rubenfeld GD, et al. Cytomegalovirus reactivation in critically ill immunocompetent patients. JAMA. 2008;3004:413-422. [CrossRef] [PubMed]
 
Stéphan F, Méharzi D, Ricci S, Fajac A, Clergue F, Bernaudin JF. Evaluation by polymerase chain reaction of cytomegalovirus reactivation in intensive care patients under mechanical ventilation. Intensive Care Med. 1996;2211:1244-1249. [CrossRef] [PubMed]
 
Domart Y, Trouillet JL, Fagon JY, Chastre J, Brun-Vezinet F, Gibert C. Incidence and morbidity of cytomegaloviral infection in patients with mediastinitis following cardiac surgery. Chest. 1990;971:18-22. [CrossRef] [PubMed]
 
Osawa R, Singh N. Cytomegalovirus infection in critically ill patients: a systematic review. Crit Care. 2009;133:R68-77. [CrossRef] [PubMed]
 

Figures

Tables

Table Graphic Jump Location
Table 1 —Patient Characteristics

Data are presented as mean ±  SD or No. (%). Group A: baseline 5 d of ICU admission; Group B: baseline 10 d of ICU admission. APACHE = Acute Physiology and Chronic Health Evaluation.

References

Ljungman P, Einsele H. Cytomegalovirus infection. Curr Opin Hematol. 1994;16:418-422. [PubMed]
 
Marik PE, Weinmann A. Cytomegalovirus in “immunocompetent,” critically ill, intensive care patients. Crit Care Med. 2001;293:681-682. [CrossRef] [PubMed]
 
Kutza AS, Muhl E, Hackstein H, Kirchner H, Bein G. High incidence of active cytomegalovirus infection among septic patients. Clin Infect Dis. 1998;265:1076-1082. [CrossRef] [PubMed]
 
Limaye AP, Kirby KA, Rubenfeld GD, et al. Cytomegalovirus reactivation in critically ill immunocompetent patients. JAMA. 2008;3004:413-422. [CrossRef] [PubMed]
 
Stéphan F, Méharzi D, Ricci S, Fajac A, Clergue F, Bernaudin JF. Evaluation by polymerase chain reaction of cytomegalovirus reactivation in intensive care patients under mechanical ventilation. Intensive Care Med. 1996;2211:1244-1249. [CrossRef] [PubMed]
 
Domart Y, Trouillet JL, Fagon JY, Chastre J, Brun-Vezinet F, Gibert C. Incidence and morbidity of cytomegaloviral infection in patients with mediastinitis following cardiac surgery. Chest. 1990;971:18-22. [CrossRef] [PubMed]
 
Osawa R, Singh N. Cytomegalovirus infection in critically ill patients: a systematic review. Crit Care. 2009;133:R68-77. [CrossRef] [PubMed]
 
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