Cytomegalovirus (CMV) reactivation has been described in adults with critical illness caused by diverse etiologies, especially severe sepsis, and observational studies have linked CMV reactivation with worse clinical outcomes in this setting. In this study, we review observational clinical data linking development of CMV reactivation with worse outcomes in patients in the intensive care unit, discuss potential biologically plausible mechanisms for a causal association, and summarize results of initial interventional trials that examined the effects of CMV prevention. These data, taken together, highlight the need for a randomized, placebo-controlled efficacy trial (1) to definitively determine whether prevention of CMV reactivation improves clinical outcomes of patients with critical illness and (2) to define the underlying mechanism(s).

中文翻译：

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目前对危重病中巨细胞病毒再激活的认识

巨细胞病毒（CMV）激活已被描述为由多种病因，尤其是严重脓毒症引起的严重疾病的成年人，并且观察性研究将CMV激活与这种情况下较差的临床结局联系起来。在这项研究中，我们审查了在重症监护病房中将CMV激活的发展与较差的结局联系起来的观察性临床数据，讨论了因果联系的潜在生物学上可行的机制，并总结了检查CMV预防作用的初步干预性试验的结果。这些数据加在一起，表明需要进行随机，安慰剂对照的功效试验（1）明确确定CMV复活的预防是否能改善危重疾病患者的临床结局，以及（2）定义潜在的机制。