The impact of cytomegalovirus infection on mechanically ventilated patients in the respiratory and geriatric intensive care units

Osman, Nehad M.; Sayed, Nehad; Abdel-Rahman, Safaa M.; Hamza, Sarah A.; Aziz, A Abdel

doi:10.1016/j.ejcdt.2013.09.022

Cited by 9 publications

(11 citation statements)

References 37 publications

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“…Table 1 and Supplementary Appendix 5 present the main characteristics of our included studies. Patient populations by study were quite variable; 3 studies included only surgical patients [ 6 , 9 , 22 ], 5 included patients with sepsis [ 11 , 12 , 20 , 25 , 26 ], 2 included burn patients [ 7 , 28 ], 6 included only mechanically ventilated patients [ 10 , 15 , 19 , 29 , 31 , 33 ], 1 included acute respiratory distress syndrome (ARDS) patients [ 33 ], and 6 used various inclusion criteria [ 13 , 14 , 27 , 30 , 32 , 34 ]. Studies published after 2006 were more likely to examine specific patient populations compared with earlier studies.…”

Section: Resultsmentioning

confidence: 99%

“…Cytomegalovirus reactivation was also associated with increased duration of mechanical ventilation (7 studies, n = 683 patients, mean difference 6.60 days, 95% CI = 3.09–10.12; P = .0002, I 2 = 79%) ( Figure 4A ). Only 7 studies [ 13 , 19 , 27 , 28 , 31–33 ] could be included because other studies were lacking any data on mechanical ventilation [ 6 , 7 , 11 , 12 , 15 , 20 , 22 , 25 , 30 , 34 ] or could not be obtained despite contacting the authors [ 9 , 10 , 14 , 26 , 29 ]. Of note, the 5 studies reporting data on ventilation but missing means and/or standard deviations all demonstrated statistically significant longer durations of mechanical ventilation in patients with CMV reactivation (Cook et al [ 9 ] mean 33 vs 13 days, Chiche et al [ 10 ] median 27 vs 10 days, Heininger et al [ 14 ] median 22 vs 8 days, von Müller et al [ 26 ] median 39 vs 16 days, and Chiche et al [ 29 ] median 24 vs 8 days, in patients with and without CMV reactivation, respectively).…”

Section: Resultsmentioning

confidence: 99%

“…Some authors have raised the possibility that CMV reactivation may simply be a marker of more severe illness [ 40 ]. For example, patients with septic shock can develop a state of immunoparalysis, also called compensatory anti-inflammatory response syndrome [ 31 ], that may increase the risk of CMV reactivation. Some have also suggested that immunoparalysis may be implicated in the increased risk of CMV reactivation associated with blood transfusion [ 7 , 41 ], a phenomenon that often occurs in ICU.…”

Section: Discussionmentioning

confidence: 99%

“…Some have also suggested that immunoparalysis may be implicated in the increased risk of CMV reactivation associated with blood transfusion [ 7 , 41 ], a phenomenon that often occurs in ICU. Moreover, bacterial infection may result in the release of endotoxin and tumor necrosis factor, which may also promote reactivation of latent CMV infection [ 31 ]. Finally, infusion of exogenous catecholamines has been shown to encourage CMV reactivation [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

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Association Between Cytomegalovirus Reactivation and Clinical Outcomes in Immunocompetent Critically Ill Patients: A Systematic Review and Meta-Analysis

Lachance¹,

Chen

Featherstone

et al. 2017

Open Forum Infectious Diseases

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BackgroundThe aim of our systematic review was to investigate the association between cytomegalovirus (CMV) reactivation and outcomes in immunocompetent critically ill patients.MethodsWe searched electronic databases and gray literature for original studies and abstracts published between 1990 and October 2016. The review was limited to studies including critically ill immunocompetent patients. Cytomegalovirus reactivation was defined as positive polymerase chain reaction, pp65 antigenemia, or viral culture from blood or bronchoalveolar lavage. Selected patient-centered outcomes included mortality, duration of mechanical ventilation, need for renal replacement therapy (RRT), and nosocomial infections. Health resource utilization outcomes included intensive care unit and hospital lengths of stay.ResultsTwenty-two studies were included. In our primary analysis, CMV reactivation was associated with increased ICU mortality (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.87–3.47), overall mortality (OR, 2.02; 95% CI, 1.60–2.56), duration of mechanical ventilation (mean difference 6.60 days; 95% CI, 3.09–10.12), nosocomial infections (OR, 3.20; 95% CI, 2.05–4.98), need for RRT (OR, 2.37; 95% CI, 1.31–4.31), and ICU length of stay (mean difference 8.18 days; 95% CI, 6.14–10.22). In addition, numerous sensitivity analyses were performed.ConclusionsIn this meta-analysis, CMV reactivation was associated with worse clinical outcomes and greater health resource utilization in critically ill patients. However, it remains unclear whether CMV reactivation plays a causal role or if it is a surrogate for more severe illness.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Association Between Cytomegalovirus Reactivation and Clinical Outcomes in Immunocompetent Critically Ill Patients: A Systematic Review and Meta-Analysis

Lachance¹,

Chen

Featherstone

et al. 2017

Open Forum Infectious Diseases

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“…In addition, the VAP can be polymicrobial, which complicates diagnosis and treatment. Regarding viruses, virus herpes simplex (HSV) [8] and cytomegalovirus (CMV) [9] can be reactivated in critical care patients and cause VAP. It should be noted that many of the pathogens causing VAP may present high levels of antibiotic resistance [2,7].…”

Section: Introductionmentioning

confidence: 99%

Assessment of a Loop-Mediated Isothermal Amplification (LAMP) Assay for the Rapid Detection of Pathogenic Bacteria from Respiratory Samples in Patients with Hospital-Acquired Pneumonia

et al. 2020

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Rapid identification of the causative agent of hospital-acquired pneumonia (HAP) will allow an earlier administration of a more appropriate antibiotic and could improve the outcome of these patients. The aim of this study was to develop a rapid protocol to identify the main microorganisms involved in HAP by loop-mediated isothermal amplification (LAMP) directly from respiratory samples. First of all, a rapid procedure (<30 min) to extract the DNA from bronchoalveolar lavage (BAL), endotracheal aspirate (EA) or bronchoaspirate (BAS) was set up. A specific LAMP for Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Stenotrophomonas maltophilia and Acinetobacter baumannii was performed with the extracted solution at 65 °C for 30–40 min. Overall, 58 positive BAL and 83 EA/BAS samples were tested. The limits of detection varied according to the microorganism detected. Validation of the LAMP assay with BAL samples showed that the assay was 100% specific and 86.3% sensitive (positive predictive value of 100% and a negative predictive value of 50%) compared with culture. Meanwhile for BAS/EA samples, the assay rendered the following statistical parameters: 100% specificity, 94.6% sensitivity, 100% positive predictive value and 69.2% negative predictive value. The turnaround time including sample preparation and LAMP was circa 1 h. LAMP method may be used to detect the most frequent bacteria causing HAP. It is a simple, cheap, sensitive, specific and rapid assay.

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Viral coinfections in COVID‐19

Aghbash

Eslami

Shirvaliloo

et al. 2021

Journal of Medical Virology

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The most consequential challenge raised by coinfection is perhaps the inappropriate generation of recombinant viruses through the exchange of genetic material among different strains. These genetically similar viruses can interfere with the replication process of each other and even compete for the metabolites required for the maintenance of the replication cycle. Due to the similarity in clinical symptoms of most viral respiratory tract infections, and their coincidence with COVID‐19, caused by SARS‐CoV‐2, it is recommended to develop a comprehensive diagnostic panel for detection of respiratory and nonrespiratory viruses through the evaluation of patient samples. Given the resulting changes in blood markers, such as coagulation factors and white blood cell count following virus infection, these markers can be of diagnostic value in the detection of mixed infection in individuals already diagnosed with a certain viral illness. In this review, we seek to investigate the coinfection of SARS‐CoV‐2 with other respiratory and nonrespiratory viruses to provide novel insights into the development of highly sensitive diagnostics and effective treatment modalities.

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The impact of cytomegalovirus infection on mechanically ventilated patients in the respiratory and geriatric intensive care units

Cited by 9 publications

References 37 publications

Association Between Cytomegalovirus Reactivation and Clinical Outcomes in Immunocompetent Critically Ill Patients: A Systematic Review and Meta-Analysis

Association Between Cytomegalovirus Reactivation and Clinical Outcomes in Immunocompetent Critically Ill Patients: A Systematic Review and Meta-Analysis

Assessment of a Loop-Mediated Isothermal Amplification (LAMP) Assay for the Rapid Detection of Pathogenic Bacteria from Respiratory Samples in Patients with Hospital-Acquired Pneumonia

Viral coinfections in COVID‐19

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