CMV reactivation in immunocompetent critically ill intensive care unit patients: a retrospective study

Abstract

Introduction: Cytomegalovirus (CMV) reactivation is observed in immunosuppressive patients and causes adverse clinical outcomes. CMV reactivation in immunocompetent patients is less known. We aimed to retrospectively investigate CMV reactivation in immunocompetent critically ill patients with bacterial growth in lower respiratory tract; and investigate the relationship between reactivation and outcomes such as length of stay (LOS), mechanical ventilation duration, and mortality.

Methodology: Intensive care unit (ICU) patients that were CMV IgG-positive, CMV IgM-negative immunocompetent, mechanically ventilated for over 48 hours, and were diagnosed with respiratory tract colonization with Acinetobacter baumannii or ventilator-associated pneumonia (VAP) were included. Reverse transcriptase polymerase chain reaction (RT-PCR) was performed on serum and endotracheal aspirate samples. The patients were divided into groups of those with and without VAP and sepsis. Reactivation rates and CMV DNA levels were compared between the groups.

Results: CMV reactivation was seen in 27 of 34 patients (79.4%). CMV DNA level was 5.8 times higher in patients with VAP and sepsis than patients without, but the difference was not statistically significant (p = 0.717). LOS and mechanical ventilation duration were higher in patients with reactivation (p = 0.047 and 0.036). No relationship was found between reactivation and mortality (p = 0.774).

Conclusions: The rate of CMV reactivation was 79.4%. This was the second-highest reactivation rate reported in the literature. The reactivation was associated with prolonged hospitalization and mechanical ventilation.