EVALUATION BY POLYMERASE CHAIN-REACTION OF CYTOMEGALOVIRUS REACTIVATION IN INTENSIVE-CARE PATIENTS UNDER MECHANICAL VENTILATION

Objective: The study was undertaken to determine if critically ill pat ients under mechanical ventilation could reactivate latent cytomegalov irus (CMV) in either lung or blood. Design: Prospective study in criti cally ill patients. Setting: The study was performed in a multidiscipl inary intensive care unit in a university hospital. Patients: 23 non-i mmunocompromised, mechanically ventilated patients who were anti-CMV i mmunoglobulin G-positive. Ten immunocompromised patients with active C MV infection and 16 asymptomatic CMV seropositive non-immunocompromise d patients constituted the positive and negative control groups. Measu rements and results: The presence of CMV in blood and bronchoalveolar lavage (BAL) was evaluated by both viral cultures and polymerase chain reaction (PCR). Thirty-seven blood and 22 BAL samples were investigat ed. Sequential samples were evaluated in 8 patients. For PCR, a 290 bp fragment in the first exon of the immediate early 1 gene was amplifie d. In order to exclude inhibitors of PCR amplification, a 268 bp fragm ent of the beta-globin gene was concurrently amplified in all samples. Viral cultures of blood and BAL were negative in all 23 non-immunocom promised, mechanically ventilated patients. Moreover, no CMV DNA could be amplified in blood or BAL samples, whereas a beta-globin amplifica tion was observed in all samples. Conclusion: In a series of 23 critic ally ill patients under mechanical ventilation who were seropositive f or CMV, no reactivation of CMV in blood or lung was demonstrated.