Detection of cytomegalovirus in severely ill patients with intractable COVID-19; a retrospective study.

Abstract

Objectives: We aimed to evaluate whether cytomegalovirus (CMV) reactivation affects the length of stay (LOS) and mortality of critically ill patients with coronavirus disease 2019 (COVID-19) following standard steroid and anti-cytokine treatments.

Study design: Retrospective data analysis of an observational cohort study.

Methods: We included all inpatients aged ≥ 20 years with severe acute respiratory syndrome coronavirus 2 infection in Northern Taiwan between May and July 2021. Blood, sputum, or endotracheal aspirate samples were collected weekly from critically ill patients with COVID-19 who did not respond to steroid treatment and sent for CMV reverse transcriptase-polymerase chain reaction testing. We investigated whether there were differences in comorbidities and prognoses between patients who tested positive for CMV and those who tested negative.

Results: Of the 167 inpatients with COVID-19, 43.3% (13/30) were critically ill, refractory to steroid treatment, and had CMV reactivation. Most (69.2%, 9/13) patients with CMV DNAemia had concurrent CMV positivity in the tracheal aspirate. Compared with CMV-negative patients, CMV-positive patients had a longer LOS but not higher 14- and 28-day mortality rates.

Conclusions: A high proportion of critically ill patients with COVID-19 who were refractory to steroid treatment developed CMV DNAemia. In critically ill patients with COVID-19, CMV reactivation can prolong hospitalization.