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To the Editor: The cohort study by Dr Limaye and colleagues¹ evaluated reactivation of cytomegalovirus (CMV) infection in critically ill patients. The study used the current generation of extremely sensitive DNA amplification tests for the detection of CMV reactivation in patients who did not have traditional reasons to be immunosuppressed. Although the findings provided the rationale for further investigation, we believe there are aspects of this study that require further research to better understand the implications of the findings.

First, the authors combined many different patient populations into the category of "critical illness," ranging from acute myocardial infarction to burn injury to sepsis. This difference in patient populations is reflected, for example, in substantial variability between the burn intensive care unit (ICU) and cardiac care ICU in the incidence of CMV reactivation (55% vs 15%, respectively) and duration of CMV reactivation (median, 20 days vs 4 days) and between the . . . [Full Text of this Article]

Amanda Peppercorn, MD
apepp@med.unc.edu

Jonathan Serody, MD
Department of Medicine

Bruce Cairns, MD
Department of Surgery
University of North Carolina
Chapel Hill

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