Department of Infectious Diseases and Clinical Microbiology, Osmaniye Kadirli State Hospital, Osmaniye, Turkiye.
Department of Infectious Diseases and Clinical Microbiology, Canakkale Onsekiz Mart University, Canakkale, Turkiye.
J Infect Dev Ctries. 2024 Oct 31;18(10):1583-1589. doi: 10.3855/jidc.19430.
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.
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.
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).
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.
巨细胞病毒（CMV）在免疫抑制患者中会被激活，并导致不良的临床后果。免疫功能正常的患者中 CMV 再激活的情况则知之甚少。我们旨在回顾性研究免疫功能正常的重症监护病房（ICU）下呼吸道细菌生长的患者中 CMV 再激活的情况；并研究再激活与住院时间（LOS）、机械通气持续时间和死亡率等结果之间的关系。
纳入 CMV IgG 阳性、CMV IgM 阴性、机械通气超过 48 小时、且被诊断为鲍曼不动杆菌或呼吸机相关性肺炎（VAP）下呼吸道定植的免疫功能正常的 ICU 患者。对血清和气管内抽吸样本进行逆转录聚合酶链反应（RT-PCR）。将患者分为 VAP 和败血症组和无 VAP 和败血症组。比较两组间的再激活率和 CMV DNA 水平。
34 例患者中有 27 例（79.4%）出现 CMV 再激活。VAP 和败血症患者的 CMV DNA 水平比无 VAP 和败血症患者高 5.8 倍，但差异无统计学意义（p = 0.717）。再激活患者的 LOS 和机械通气持续时间更高（p = 0.047 和 0.036）。再激活与死亡率之间未发现相关性（p = 0.774）。
CMV 再激活率为 79.4%。这是文献中报道的第二高的再激活率。再激活与住院时间和机械通气时间延长有关。
