Cytomegalovirus Reactivation in Intensive Care Unit Patients: Should It Be Treated?

In the past 2 decades, numerous studies have reported viral “nosocomial” infections in nonimmunocompromised intensive care unit (ICU) patients. These infections are mainly reactivation of viruses from the herpes group, and especially the cytomegalovirus (CMV). Although these viral reactivations had often been discussed with the assumption that they were only the marker of the severity of patients’ illness rather than a real disease, several studies and meta-analyses then suggested that they may represent an independent risk factor for the mortality and the major morbidity in ICU patients. Hence, this situation may create a dilemma for the clinician. On the one hand, there are strong arguments for treating CMV reactivation in ICU patients. First, CMV reactivation is associated with a poorer outcome. Second, CMV reactivation may lead to CMV pneumonia. Third, CMV reactivation may also lead to immunoparalysis, which can favor other bacterial and/or fungal infections. Finally, in a murine model of CMV postseptic reactivation, ganciclovir prophylaxis had a significant protective effect on lung fibrosis. On the other hand, there are also several arguments against treating CMV reactivation, including mainly a high rate of toxicity of available antivirals. Currently, definitive proof of causality demonstrating CMV pathogenicity still awaits controlled clinical trials of specific antiviral therapies. Pending these results, antiviral treatment should be discussed in certain circum...
Source: Clinical Pulmonary Medicine - Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research