The adverse impact of cytomegalovirus infection on intensive care units outcomes in critically ill COVID-19 patients: a single-center prospective observational study.

Summary

In 431 ICU patients with COVID-19 ARDS, CMV co-infection occurred in 14.8% and independently predicted higher hospital mortality (OR 4.91). Earlier reactivation was linked to increased mortality risk, and CMV positivity associated with more ICU-acquired infections and longer hospitalization.

Key Findings

• CMV co-infection detected in 14.8% (64/431) of ICU COVID-19 ARDS patients.
• CMV positivity associated with higher ICU mortality (43.8% vs. 13.6%) and hospital mortality (48.4% vs. 13.6%).
• CMV infection independently predicted hospital mortality (OR 4.91), and earlier reactivation increased mortality risk (time-dependent HR 0.94 per day delay).

Clinical Implications

Implement early CMV DNA surveillance (plasma/BAL) on ICU admission for COVID-19 ARDS and consider pre-emptive antiviral strategies in high-risk patients.

Limitations

• Single-center design limits generalizability.
• Observational nature; antiviral interventions were not randomized or protocolized.

Future Directions

Conduct multicenter trials to test CMV pre-emptive therapy triggers and clarify causal pathways between CMV reactivation and secondary infections in ARDS.