Safety and Efficacy of Antiviral Therapy for Prevention of Cytomegalovirus Reactivation in Immunocompetent Critically Ill Patients

Abstract

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Surviving sepsis campaign: research priorities for sepsis and septic shock

“…In contrast, a single center trial of 124 CMV-seropositive patients undergoing mechanical ventilation randomized patients to receive anti-CMV prophylaxis with valacyclovir or low-dose valganciclovir. While valacyclovir decreased viral reactivation in the blood (12 patients vs. 2 patients), this finding was associated with an increase in 28-day mortality in patients receiving valacyclovir (41.2% in treatment arm vs. 13.5% mortality in control arm) [36].…”

Herpes simplex virus and Cytomegalovirus reactivation among severe ARDS patients under veno-venous ECMO

“…However, despite these associations, the debate on the proper pathogen role of Herpesviridae rather than being a witness of patients' severity is still ongoing. Studies failed to demonstrate that CMV prophylaxis was able to decrease Il-6 plasma levels in CMV seropositive critically ill patients [11] or to decrease mortality [12]. The role of Herpesviridae pre-emptive treatment among ICU patients has been recently evaluated in a randomized controlled trial (RCT) (NCT 02152358).…”

Cytomegalovirus is still in intensive care

“…The results confirm that CMV reactivation is common in ICU patients that viral load duration and quantity can be reduced by ganciclovir at the dose chosen and that this drug can be administered safely to ICU patients . The results, and those of another ICU study, also show that a much larger number of patients will be required to determine if ganciclovir can produce clinical benefits . Now that we know that ganciclovir is safe in this patient population, the study could be conducted by giving drug or placebo immediately on admission to an ICU, without waiting for the results of CMV IgG tests.…”

“…8 The results, and those of another ICU study, also show that a much larger number of patients will be required to determine if ganciclovir can produce clinical benefits. 11 Now that we know that ganciclovir is safe in this patient population, the study could be conducted by giving drug or placebo immediately on admission to an ICU, without waiting for the results of CMV IgG tests. Patients found to be CMV seropositive could then continue with drug or placebo to form the major study group.…”