Human cytomegalovirus infections in nonimmunosuppressed critically ill patients

Objective: To assess the occurrence of active human cytomegalovirus (HCMV) infection and HCMV disease and to evaluate potential risk factors in immuno competent intensive care patients after major surgery or trauma. Design: A prospective clinical study. Setting: An anesthesiological intensive care unit (ICU) in a university hos pital. Patients: Fifty-six anti-HCMV immunoglobulin G (IgG) seropositive patients without manifest immunodeficiency whose simplified acute physiology score ( SAPS II) value rose to greater than or equal to 41 points during their ICU stay, Interventions: Once a week, the patients were examined for active HCMV infe ction by polymerase chain reaction and by viral cultures from blood and low er respiratory tract secretions, Three times a week, detailed clinical exam ination for signs of HCMV disease was carried out. Measurements and Main Results: Twenty of the 56 ICU patients (35.6%) who me t the study criteria of a SAPS II score >40 points and anti-HCMV IgG seropo sitivity developed an active HCMV infection as diagnosed by the detection o f HCMV DNA in leukocytes, plasma, or respiratory tract secretions. In seven patients, the virus was isolated in the respiratory tract secretions. Seve re HCMV disease appeared in two patients with pneumonia or encephalitis res pectively. In patients with active HCMV infection, the mortality tended to be higher (55%) than in those without (36%); the duration of intensive care treatment of the survivors was significantly longer in the patients with a ctive HCMV infection (median 30 vs. 23 days; p = .0375). Univariate testing for factors associated with active HCMV infection showed the importance of sepsis at admission (p =.011) and prolonged pretreatment on the ward or in an external ICU (p = .002); the relevance of underlying malignant disease was borderline (p = .059), Multiple regression analysis identified only sep sis to be independently associated with active HCMV infection (p = .02; odd s ratio, 4.62). Conclusions: Even in a group of ICU patients without manifest immunodeficit who were anti-HCMV IgG seropositive and had reached a SAPS II score of gre ater than or equal to 41 points, active HCMV infection occurred frequently (35.6%). Septic patients were affected twice as often as the total study po pulation. In 2 of the 20 cases, active HCMV infection progressed to severe HCMV disease. Proper diagnosis demands special clinical attention combined with extended virological examinations. Further studies in a larger patient group should evaluate the influence of HCMV on ICU mortality.