To the Editor We read with interest the Original Investigation by Cowley and colleagues1 on antiviral therapy to prevent cytomegalovirus (CMV) reactivation in patients who are immunocompetent and in the intensive care unit (ICU).1 The strategy to suppress CMV replication has been studied in solid organ transplants, in which both prophylaxis and preemptive treatment is accepted as standard of care. In patients in the ICU, CMV reactivation occurs in 35% of patients who are seropositive and has been associated with worse outcomes: a longer stay in the ICU and/or hospital, longer need for organ support, higher risk for bacterial infections, and increased mortality.2 Cowley and colleagues1 mention a direct correlation between CMV viral load and mortality but this association has not been shown. There is a correlation between CMV viral load and a combined end point of mortality and continued hospitalization at day 30, but the correlation between viral load and mortality as such has not been evaluated.3
De Vlieger G, Van Wijngaerden E. Cytomegalovirus in Patients in the Intensive Care Unit. JAMA Intern Med. 2017;177(10):1541–1542. doi:10.1001/jamainternmed.2017.4395
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