Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA.
J Infect Dis. 2020 Mar 5;221(Suppl 1):S94-S102. doi: 10.1093/infdis/jiz638.
Cytomegalovirus (CMV) reactivation has been described in adults with critical illness caused by diverse etiologies, especially severe sepsis, and observational studies have linked CMV reactivation with worse clinical outcomes in this setting. In this study, we review observational clinical data linking development of CMV reactivation with worse outcomes in patients in the intensive care unit, discuss potential biologically plausible mechanisms for a causal association, and summarize results of initial interventional trials that examined the effects of CMV prevention. These data, taken together, highlight the need for a randomized, placebo-controlled efficacy trial (1) to definitively determine whether prevention of CMV reactivation improves clinical outcomes of patients with critical illness and (2) to define the underlying mechanism(s).
巨细胞病毒（CMV）再激活已在由多种病因引起的危重病成人患者中被描述，尤其是严重脓毒症，并且观察性研究已经将 CMV 再激活与该环境下更差的临床结局相关联。在这项研究中，我们回顾了将 CMV 再激活与重症监护病房患者的不良结局相关联的观察性临床数据，讨论了因果关联的潜在生物学合理机制，并总结了最初检查 CMV 预防效果的干预性试验的结果。这些数据共同强调了进行随机、安慰剂对照疗效试验的必要性，以（1）明确确定预防 CMV 再激活是否改善危重病患者的临床结局，以及（2）确定潜在的机制。
