The adverse impact of cytomegalovirus infection on intensive care units outcomes in critically ill COVID-19 patients: a single-center prospective observational study.
Marina López-Olivencia, Raúl de Pablo, Noemí Paredes de Dios, Susana García-Plaza, Sergio Sáez-Noguero, Javier Sáez de la Fuente, Jesús Fortún, María Cruz Soriano Cuesta
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引用次数: 0
Abstract
Purpose: To assess the incidence and clinical impact of CMV infection in critically ill COVID-19 patients, examining ICU and hospital mortality, and length of hospital stay.
Methods: In this single-center, prospective observational study (March 2020 - September 2022), 431 patients with COVID-19 pneumonia and moderate to severe ARDS were included. An active CMV surveillance protocol was implemented, analyzing CMV DNA in plasma and bronchoalveolar lavage (BAL). Clinical characteristics and outcomes were compared between CMV-COVID co-infected patients and those without CMV reactivation.
Results: CMV-COVID co-infection was detected in 14.8% (64/431) of the cohort. Patients with CMV-COVID co-infection exhibited significantly higher ICU mortality (43.8% vs. 13.6%; p < 0.001) and hospital mortality (48.4% vs. 13.6%; p < 0.001) compared to patients without CMV. CMV infection was an independent predictor of hospital mortality (OR 4.91; 95% CI 2.76-8.75; p = 0.019). Earlier CMV reactivation was associated with an increased risk of hospital mortality (HR = 0.94; 95% CI: 0.90-0.98; p = 0.003). Additionally, CMV-COVID patients had a higher incidence of ICU-acquired infections and a prolonged hospital stay.
Conclusions: In critically ill patients with SARS-CoV-2 pneumonia, CMV infection was frequently observed, and associated with increased ICU and hospital mortality. CMV co-infection correlated with a higher incidence of ICU-acquired bacterial and fungal infections and prolonged hospital stays. This emphasizes the importance of early CMV monitoring upon ICU admission, as timely detection and intervention could potentially mitigate its impact on patient outcomes.
目的:评估COVID-19危重症患者巨细胞病毒感染的发生率和临床影响,考察ICU和住院死亡率以及住院时间。方法:在这项单中心前瞻性观察研究中(2020年3月至2022年9月),纳入了431例COVID-19肺炎和中重度ARDS患者。实施主动CMV监测方案,分析血浆和支气管肺泡灌洗液(BAL)中的CMV DNA。比较CMV- covid合并感染患者和未CMV再激活患者的临床特征和结局。结果:14.8%(64/431)的队列检测到CMV-COVID合并感染。CMV-COVID合并感染患者ICU死亡率明显高于CMV-COVID合并感染患者(43.8% vs 13.6%;结论:在SARS-CoV-2肺炎危重患者中,CMV感染是常见的,并与ICU和住院死亡率增加相关。巨细胞病毒合并感染与icu获得性细菌和真菌感染的较高发生率以及住院时间延长相关。这强调了在ICU入院时早期CMV监测的重要性,因为及时发现和干预可能会减轻其对患者预后的影响。
期刊介绍:
Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings.
The journal covers a wide range of topics, including:
Etiology: The study of the causes of infectious diseases.
Pathogenesis: The process by which an infectious agent causes disease.
Diagnosis: The methods and techniques used to identify infectious diseases.
Treatment: The medical interventions and strategies employed to treat infectious diseases.
Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies.
Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections.
In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.