Çimendağ Hacer Ceylan, Sayıner Arzu, Gökmen Ali Necati, Avkan-Oğuz Vildan
Department of Infectious Diseases and Clinical Microbiology, Dokuz Eylül University School of Medicine, İzmir, Türkiye.
Department of Medical Microbiology, Dokuz Eylül University School of Medicine, İzmir, Türkiye.
Infect Dis Clin Microbiol. 2025 Jun 26;7(2):174-184. doi: 10.36519/idcm.2025.480. eCollection 2025 Jun.
Monitoring cytomegalovirus (CMV) plasma DNAemia is not used in routine clinical practice for immunocompetent patients. However, immunocompetent patients in the intensive care unit (ICU) may develop transient immunosuppression due to severe illness and its treatment, potentially leading to CMV reactivation. This study aimed to investigate the incidence, risk factors, and clinical outcomes of CMV reactivation in non-immunocompromised patients in the intensive care unit (ICU).
Patients admitted to the Internal Medicine and Anesthesia ICUs were included. CMV-seropositive patients who met inclusion criteria were monitored daily. Quantitative real-time polymerase chain reaction (qPCR) was performed on days 0, 3, 7, 14, 21, and 28 to determine CMV plasma DNAemia. Patients' data was recorded and analyzed by dividing them into reactivation and non-reactivation groups.
CMV reactivation occurred in 26 of 146 patients (17.8%), with a mean onset of 10 ± 4.72 days after ICU admission (range: 3-21 days). The reactivation rates in different ICU populations were found to be 31.5% in patients with septic shock, 25% in those with COVID-19, 23.8% in those with sepsis, 18.4% in mechanically ventilated patients, and 11.4% following trauma or surgery. In multivariate analysis, sepsis at ICU admission (odds ratio [OR] 2.88, 95% confidence interval [CI]: 1.017-8.157), Acute Physiology and Chronic Health Evaluation II (APACHE II) score at ICU admission (OR 1.062, 95% CI: 1.003-1.126), and duration of illness before admission (OR 1.048, 95% CI: 1.001-1.097) were independently associated with CMV reactivation. The incidence of fungemia after ICU admission was significantly higher in the group with CMV reactivation. Mortality rates, ICU duration, and hospital stay were comparable between the two groups.
Consistent with previous studies, our findings suggested that the presence of infection, especially sepsis, during ICU admission is the most significant risk factor for CMV reactivation. The identification of sepsis and high APACHE II score as independent risk factors supported the association between severe sepsis-related illness and CMV reactivation. In patients with risk factors, CMV reactivation may serve as a marker of disease severity and the level of immunosuppression.
监测巨细胞病毒（CMV）血浆病毒血症在免疫功能正常患者的常规临床实践中并不常用。然而，重症监护病房（ICU）中的免疫功能正常患者可能因严重疾病及其治疗而出现短暂的免疫抑制，这可能导致CMV重新激活。本研究旨在调查重症监护病房（ICU）中非免疫受损患者CMV重新激活的发生率、危险因素和临床结局。
纳入内科和麻醉科ICU收治的患者。符合纳入标准的CMV血清学阳性患者每天进行监测。在第0、3、7、14、21和28天进行定量实时聚合酶链反应（qPCR）以确定CMV血浆病毒血症。将患者数据记录并分为重新激活组和未重新激活组进行分析。
146例患者中有26例（17.8%）发生CMV重新激活，ICU入院后平均发病时间为10±4.72天（范围：3 - 21天）。不同ICU人群中的重新激活率分别为：感染性休克患者31.5%，新冠肺炎患者25%，脓毒症患者23.8%，机械通气患者18.4%，创伤或手术后患者11.4%。多因素分析显示，ICU入院时的脓毒症（比值比[OR]2.88，95%置信区间[CI]：1.017 - 8.157）、ICU入院时的急性生理与慢性健康状况评分系统II（APACHE II）评分（OR 1.062，95%CI：1.003 - 1.126）以及入院前疾病持续时间（OR 1.048，95%CI：1.001 - 1.097）与CMV重新激活独立相关。CMV重新激活组ICU入院后真菌血症的发生率显著更高。两组之间的死亡率、ICU住院时间和住院时间相当。
与先前研究一致，我们的研究结果表明，ICU入院时存在感染，尤其是脓毒症，是CMV重新激活的最重要危险因素。将脓毒症和高APACHE II评分确定为独立危险因素支持了严重脓毒症相关疾病与CMV重新激活之间的关联。在有危险因素的患者中，CMV重新激活可能作为疾病严重程度和免疫抑制水平的标志物。
