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Intensive Care Medicine

, Volume 42, Issue 1, pp 28–37 | Cite as

Cytomegalovirus reactivation in ICU patients

  • Laurent PapazianEmail author
  • Sami Hraiech
  • Samuel Lehingue
  • Antoine Roch
  • Laurent Chiche
  • Sandrine Wiramus
  • Jean-Marie Forel
My Paper 20 Years Later

Abstract

Introduction

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.

Major findings

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.

Discussion

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.

Conclusion

Cytomegalovirus infection may affect health outcomes for ICU patients. Additional prospective trials are necessary to confirm this hypothesis.

Keywords

Cytomegalovirus ICU Mechanical ventilation Mortality Incidence Reactivation 

Notes

Compliance with ethical standards

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Financial support

No financial support.

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • Laurent Papazian
    • 1
    • 2
    Email author
  • Sami Hraiech
    • 1
    • 2
  • Samuel Lehingue
    • 1
    • 2
  • Antoine Roch
    • 1
    • 3
  • Laurent Chiche
    • 4
  • Sandrine Wiramus
    • 5
  • Jean-Marie Forel
    • 1
    • 2
  1. 1.Faculté de MédecineAix-Marseille Université, URMITE UMR CNRS 7278MarseilleFrance
  2. 2.Réanimation des Détresses Respiratoires et des Infections SévèresAssistance Publique-Hôpitaux de Marseille, Hôpital NordMarseilleFrance
  3. 3.Service d’accueil des UrgencesAssistance Publique-Hôpitaux de Marseille, NordMarseilleFrance
  4. 4.Département de Médecine InterneHôpital EuropéenMarseilleFrance
  5. 5.Service d’Anesthésie-RéanimationAssistance Publique-Hôpitaux de Marseille, Hôpital de la ConceptionMarseilleFrance

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