Table 1.
Overview of the rate and timing of CMV reactivation in observational studies in critically ill patients.
| Study design | Study period | Study population | Severity scores | n | % CMV IgG | Samples | Detection method | Reactivaton rate | Time to reactivation (days) | |
|---|---|---|---|---|---|---|---|---|---|---|
| Domart et al. (18) | Prospective observational | 1981–1986 | Mediastinitis after cardiac surgery | APACHE II 14.6 ± 7.3 | 115 | – | Urine and blood | Culture | 25.2% | 37 ± 22 |
| Cook et al. (19) | Retrospective case control | 1989–1994 | Persistent sepsis SICU |
APACHE II 13.0 ± 1.3 when reactivation, 14.2 ± 0.8 when no reactivation |
142 | – | Blood, BAL, sputum, skin | Culture | 14% (CMV and HSV) | – |
| Kutza et al. (20) | Prospective observational | –a | Sepsis | 34 | 93.90% | Blood | pp65 and PCR | 32.4% | PCR: 4 pp65: 11 |
|
| Heininger et al. (21) | Prospective observational | 1998–1999 | SAPS II > 41 in SICU | SAPS II 42.2 ± 13.5 | 56 | 100% | Plasma, leukocytes, LRT | Culture and PCR | 35.60% | 10.8 |
| Cook et al. (22) | Prospective observational | 15 monthsa | SICU LOS > 5 days | APACHE II 13.1 ± 0.5 | 104 | 73.10% | Blood and LRT | Culture | 15% in respiratory tract, 5.8% in blood | 28 ± 4 |
| Jaber et al. (23) | Retrospective case control | 1995–2001 | Fever > 72 hours | SAPS II 50 ± 16 | 40 and 40 controls | – | Blood | pp65 | 17% | 20 ± 12 |
| Von müller et al. (24) | Prospective observational | 9 monthsa | Septic shock and ICU LOS ≥ 7 days | SOFA 10 | 25 | 100% | Blood | pp65 | 32% | – |
| Limaye et al. (25) | Prospective observational | 2004–2006 | Mixedb | APACHE II 21 (range 7–36) | 120 | 100% | Plasma | PCR | 33%; >1000 copies in 20% | 12 (range 3–57) |
| Ziemann et al. (26) | Retrospective observational | 2001 and 2003–2004 | SICU with LOS > 14 days | – | 99 | 73% | Plasma | PCR | 35% | 17.0 ± 15.3 |
| Chiche et al. (27) | Prospective observational | 2 yearsa | MICU and MV ≥2 days | SAPS II 48 ± 17 SOFA 9 (IQR 6–11) |
242 | 80% | Blood and BAL | pp65 on blood, culture on BAL | 16.10% | 16 (6–25) |
| Chilet et al. (28) | Prospective observational | 2008–2009 | Surgical and trauma ICU and ICU LOS > 5 days | – | 53 | 100% | Plasma and tracheal aspirate | PCR | 39.7% (in blood 30.2%) | 16.5 (0–28) in plasma |
| Bordes et al. (29) | Prospective observational | 2008–2010 | Burns, TBSA > 15% | – | 29 | 72.40% | Blood | PCR | 51.70% | 13 ± 9 |
| Heininger et al. (30) | Prospective observational | 2004–2006 | Severe sepsis | SAPS II 43.0 (IQR 36–51) SOFA 8.0 (IQR 7–11) |
97 (86 analyzed) | 100% | Plasma, leukocytes and LRT | PCR | 40.7% (in blood 11.6%) | 24.5 (range 0–49) |
| Chiche et al. (31) | Prospective case control | 2008–2011 | MICU and MV > 2 days | SAPS II 48 SOFA 9 |
15, 15 controls | 100% | Blood | pp65 | 27% | 5 (3–19) |
| Coisel et al. (32) | Prospective observational | 1 yeara | MICU, MV, and suspected pneumonia | SAPS II 45 (IQR 31–55) | 93 | 77% | Blood and BAL | pp65 on blood, PCR on BAL | 23.7% | – |
| Bravo et al. (33) | Prospective observational | 2008–2009 and 2011–2012 | SICU | APACHE II 21 (range 10–39) SAPS II 48 (range 23–82) |
78 | 100% | Plasma, LRT and saliva | PCR | 46%c | 10 (range 0–34) |
| Osman et al. (34) | Prospective observational | 3 monthsa | MV | – | 51 | – | Serum | PCR | 68.6% | – |
| Walton et al. (14) | Prospective observational | 2009–2013 | Mixed ICU | APACHE II18 in septic and 5 in nonseptic SOFA 7 in septic, 2 in nonseptic |
720 | 70.2% | Whole blood and plasma | PCR | 24.2% | – |
| Al-Musawi et al. (35) | Retrospective case control | 2010–2013 | Mixed ICU, thrombopenia | APACHE II 21 when no reactivation 27 when reactivation |
52, 47 controls | 83.8% | Plasma | PCR | – | – |
| Frantzeskaki et al. (36) | Prospective observational | 2010–2012 | MV in mixed ICU | APACHE II 20 range 4–43 | 80 | 100% | Plasma | PCR | 13.75% | 7 |
| Lopez Roa et al. (37) | Prospective observational | 2004–2006 | Mixed ICU | APACHE II median 21 (range 7–36) | 115 | 100% | Plasma | PCR | 34.0% | 12 (range 3–57) |
| Ong et al. (38) | Prospective observational | 2011–2013 | ARDS and MV for at least 4 days | APACHE III 79–81 | 306 | 100% | Plasma | PCR | 26.0% | – |
| Osawa et al. (39) | Prospective observational | BSI | APACHE II 28 when reactivation 24 when no reactivation |
100 | 100% | Plasma | PCR | 20.0% | – | |
| Ong et al. (40) | Prospective observational | 2011–2013 | ARDS and MV for at least 4 days | APACHE IV 91 when reactivation 76 when no reactivation |
271 | 100% | Plasma | PCR | 27.0% | 8.5 |
| Ong et al. (41) | Prospective observational | 2011–2014 | Septic shock and ICU LOS > 4 days | APACHE IV 85 when reactivation 82 when no viral reactivationd |
399 | 65% | Plasma | PCR | 27.0% | – |
| Hraiech et al. (42) | Retrospective obervational | 2011–2017 | Severe ARDS with vvECMO ≥2 days | SAPS II 51 | 123 | –e | Blood and BAL | PCR | 17.9% in blood 22.0% in blood and BAL | – |
study period not mentioned in the original manuscript.
burns TBSA at least 40 or 20% and inhalation injury, TICU with ISS >15 and TF of more than 4U PC, MICU with sepsis, CICU with acute myocardial infarction.
CMV reactivation includes BAL positivity without viraemia.
viral reactivation includes also other herpes viridae (CMV, Epstein-Barr virus, Human herpesvirus 6, herpes simplex virus (HSV) type 1, HSV type 2, and varicella zoster virus).
estimated high by authors based upon epidemiology.
N, number; CMV, cytomegalovirus; IgG, antibodies; APACHE, acute physiology and chronic health evaluation II; SICU, surgical intensive care unit; BAL, broncho-alveolar lavage; HSV, herpes simplex virus; PCR, polymerase chain reaction; pp65, CMV antigen; SAPS II, simplified acute physiology score II; LRT, lower respiratory tract; LOS, length of stay; SOFA, sequential organ failure assessment; MICU, medical intensive care unit; MV, mechanical ventilation; IQR, interquartile range; TBSA, total body surface area; ARDS, acute respiratory distress syndrome; vvECMO, veno-venous extracorporeal membrane oxygenation.