The pathogenetic role of CMV in intensive care unit patients: the uncertainity remains

More than two decades ago, Domart and colleagues (1) were the first to hint at a pathogenetic role for CMV in non-canonically immunosuppressed critically ill patients. In a cohort of 115 consecutive adult patients with mediastinitis after cardiac surgery, CMV shedding in urine, as determined by viral culture, was documented in 25% of patients of whom 79% had viremia. CMV shedding was found to be associated with persistence of local infection, prolonged hospitalization, and increased late mortality. Since then, a great body of experimental evidence has been gathered on this subject. We now know that CMV-seropositive patients frequently experience one or more CMV replicative episodes (CMV reactivations) during critical illness, most notably burn or septic patients (2-11).