Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2025 Jul 22;25(1):2522.
doi: 10.1186/s12889-025-23753-6.

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

Yea-Yuan Chang  1   2   3 , Shu-Chen Kuo  4   5 , Stephane Wen-Wei Ku  6   7
Affiliations
Observational Study

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

Yea-Yuan Chang et al. BMC Public Health. .

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.

Keywords: COVID-19; Critically ill; Cytomegalovirus (CMV); Length of stay; Pneumonia; Steroid.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The Institutional Review Board of Taipei City Hospital’s Ethics Committee approved this study (IRB No. TCHIRB-11008016-E). All patient data were anonymized and disconnected, with no minors included in the study. The IRB waived the requirement for written informed consent. Consent for publication: Not applicable. This study does not contain any individual person’s data in any form. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The possible mechanisms and effects of CMV reactivation in patients infected with SARS-CoV-2
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Zhang Z, Liu X, Sang L, et al. Cytomegalovirus reactivation in immunocompetent mechanical ventilation patients: a prospective observational study. BMC Infect Dis. 2021;21(1):1026. - PMC - PubMed
    1. Imlay H, Limaye AP. Current understanding of cytomegalovirus reactivation in critical illness. J Infect Dis. 2020;221(Suppl 1):S94-102. - PMC - PubMed
    1. Schinas G, Moustaka V, Polyzou E, Almyroudi MP. Targeting CMV reactivation to optimize care for critically ill COVID-19 patients: a review on the therapeutic potential of antiviral treatment. Viruses. 2023;15(5):1165. - PMC - PubMed
    1. Gozukucuk R, Kilic HH. The relationship between CMV reactivation, anti-cytokine treatment and mortality in critical COVID-19 patients. Pak J Med Sci. 2023;39(5):1286–90. - PMC - PubMed
    1. Yamamoto Y, Shiroyama T, Hirata H, et al. Prolonged corticosteroid therapy and cytomegalovirus infection in patients with severe COVID-19. J Med Virol. 2022;94(3):1067–73. - PMC - PubMed

Publication types