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. 2023 Oct 1;42(10):875-882.
doi: 10.1097/INF.0000000000004027. Epub 2023 Jul 21.

Cytomegalovirus Active Infection in Critically Ill Children

Sarah Cazella Schwab  1 , Aparecida Yulie Yamamoto  2 , Davi Casale Aragon  1 , Ana Paula de Carvalho Panzeri Carlotti  1
Affiliations

Cytomegalovirus Active Infection in Critically Ill Children

Sarah Cazella Schwab et al. Pediatr Infect Dis J. .

Abstract

Objective: To describe the epidemiology, clinical characteristics and outcomes of children with cytomegalovirus (CMV) active infection in the pediatric intensive care unit (PICU) and to investigate risk factors for mortality.

Methods: This was a retrospective cohort study of patients who had CMV DNA detected in blood samples and/or tracheal aspirates by polymerase chain reaction (PCR) during stay at 2 PICUs of a university hospital. Suspected cases without etiological confirmation and patients with laboratory-confirmed CMV infection before PICU admission were excluded.

Results: Demographic, clinical and outcome data were collected from medical records. From January 1, 2012, to December 31, 2019, 4748 children were admitted to the PICUs. Thirty-five (0.74%; 95% CI 0.51%-1.02%) had laboratory-confirmed CMV active infection; 71.4% were immunocompromised and 11 (31.4%) died. Patients who died were older than those who survived (median age 65 vs. 5.5 months, respectively; P = 0.048), and they received antiviral therapy for a shorter time (median 12 vs. 23 days, respectively; P = 0.001). The main causa mortis was septic shock (82%) and in most deceased patients (73%) the last CMV PCR before death was positive. PELOD score >6 was a risk factor for death (RR 2.96; 95% CI 1.07-8.21). Viral load in blood had a poor ability for the prediction of death (area under the receiver operating characteristic curve 0.62; 95% CI 0.37-0.84).

Conclusions: The incidence of CMV active infection during PICU stay was 0.74% in an upper-middle income country with a high CMV seroprevalence. PELOD score higher than 6 was a risk factor for death. No association was observed between CMV viral load and mortality.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

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