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Table 1 Characteristics of studies assessing the rate and outcome of cytomegalovirus infection in critically ill patients

From: Cytomegalovirus infection in critically ill patients: a systematic review

     CMV infection Outcome CMV positive vs. negative
Study Inclusion criteria Number of patients CMV IgGa Frequency of monitoring Assay (specimen) Ratea Time to positivity, dayb Mortality, death/total (%) ICU stay, dayb
[13] ICU, mediastinitis after cardiac surgery 115 22/78 (28) Every 3 weeks Culture (blood, urine) 29/115 (25) 37 ± 22c 16/29 (55) vs. 31/86 (36) (NS) 69 ± 36 vs. 48 ± 27 (P < 0.05)
      Culture (blood) 23/115 (20)    
[6] ICU, sepsis 60 33/44 (75) Once Culture, antigenemia, PCR (blood) 43/44 (98) ND ND ND
[14] ICU, mechanical ventilation 23 23/23 (100) Randomd PCR, culture (blood) 0/23 (0) NA NA NA
     Randome PCR, culture (BAL) 0/14 (0)    
[17]f SICU, postoperative sepsis with no identifiable sources 142 ND Once, day 30 ± 5g Culture (blood, sputum, BAL) 12/142 (8.5) NA 8/12 (66) vs. 45/130 (35) ND
[7] ICU, sepsis 34 31/33 (94) Twice weekly PCR (blood) 11/34 (32) 4 (1–23) 7/11 (64) vs. 17/23 (74) (NS) ND
      Antigenemia 6/34 (18) 11 (1–23)   
[12] ICU, ≥ 2 organ failures 48 ND Once, day 1.8 ± 2.2b PCR (blood) 1/48 (2.1) NA 1/1 (100) vs. 15/47 (32) (NS) ND
      Antigenemia 0/48 (0)    
[10] ICU, SAPS II ≥ 41 56 56/56 (100) Every week PCR (blood, LRT secretions) 20/56 (36) 11 11/20 (55) vs. 13/36 (36) (NS) 30 vs. 23 (P = 0.0375)
      PCR (blood) 18/56 (32)    
      Culture (LRT secretions) 7/56 (13)    
      Culture (blood) 0/56 (0)    
[15] ICU 120 ND Once, day 4 PCR (blood) 1/120 (0.8) NA ND ND
[8] SICU stay ≥ 5 days 104 76/104 (73) Every week Culture (blood, LRT secretions) 10/104 (10) 28 ± 4g 5/10 (50) vs. 25/94 (27) (NS) 41 vs. 19 (P = 0.001)
      Culture (blood) 6/104 (5.8)    
[18] ICU, fever > 72 hours without evidence of bacteriologic or fungal origin 237 ND Clinical judgment Antigenemia 40/237 (17) 20 ± 12 20/40 (50) vs. 11/40 (28) (P = 0.02) 41 ± 28 vs. 31 ± 22 (P = 0.04)
[16] ICU stay ≥ 7 days, septic shock 25 25/25 (100) Twice weekly in week 1, then every week Antigenemia 8/25 (32) 7 (0–14) 5/8 (63) vs. 6/17 (35) (NS) 42 (16–87) vs. 18 (10–42) (P = 0.0025)
      Culture (blood, LRT secretions, urine) 4/25 (16)    
      Culture (blood) 1/25 (4)    
[11] ICUh 120 120/120 (100) Three times weekly PCR (blood) 39/120 (33) 12 (3–57) CMV viremia at any level is associated with continued ICU hospitalization or death at day 30 (OR 5.7, 95% CI 2.1–15.6)  
[9] ICU stay ≥ 14 days 99 41/56 (73) Randomi PCR (blood) 35/99 (35)j 17 ± 15 10/35 (29) vs. 7/64 (11) (P = 0.048) 33 ± 19 vs. 22 ± 11 (P < 0.001)
  1. BAL = bronchoalveolar lavage; CI = confidence interval; CMV = cytomegalovirus; ICU = intensive care unit; LRT = lower respiratory tract; NA = not applicable; ND = no data available; NS = not significant; OR = odds ratio; PCR = polymerase chain reaction; SAPS = simplified acute physiologic score; SICU = surgical intensive care unit.
  2. a Data were presented as positive/total (%).
  3. b Data were presented as mean ± standard deviation or median (range) unless otherwise indicated.
  4. c Time was measured after heart surgery.
  5. d Blood was collected at a mean of five days for the first sample and 17 days (range: 6 to 29 days) for the others.
  6. e BAL was performed at a mean of 19 days (range: 1 to 41 days).
  7. f Data were presented as combined outcomes of patients with CMV or herpes simplex virus infection in the original article. Data regarding CMV infection were extracted for this review.
  8. g Data were presented as mean ± standard error of mean.
  9. h This included admission to the burn ICU with at least 40% body surface burn or at least 20% body surface burn with inhalation injury, to the trauma ICU with in Injury Severity Score > 15 and > 4 unit packed red blood cells within 24 hours, to the medical ICU with suspected or documented sepsis, or to the cardiac care ICU with a diagnosis of acute myocardial infarction.
  10. i Blood was collected randomly and was stored for red blood cell cross-matching. The first blood samples were drawn on day 6.6 ± 8.2, and the last blood samples were drawn on day 20 ± 16.
  11. j 23 of 41 (56%) CMV seropositive patients developed CMV infection.