2506. Reactivation of Latent Cytomegalovirus Infection Following Major Surgery: Risk Factors and Outcomes

Abstract

BackgroundReactivation of latent cytomegalovirus infection can occur in nonimmunocompromised individuals during critical illness and may be associated with increased morbidity and mortality. However, few studies have focused on patients undergoing major surgery. Our aim was to explore risk factors for and outcomes following CMV reactivation in nonimmunocompromised post-operative patients.MethodsWe performed a retrospective case–control study of nonimmunocompromised patients with CMV reactivation following major surgery from 2004 to 2016. Cases included patients testing positive for CMV by viral load, viral culture or histopathology. Controls were matched to cases 2:1 by age, sex, type and year of surgery. Groups were compared using conditional logistic regression.Results16 patients with CMV were matched to 32 controls. Median age was 65 (range 34–84) and 50% were male. The most common surgeries were abdominal (44%) and cardiac (25%). Median time from surgery to CMV diagnosis was 32 days (range 17–93). Patients had a range of clinical symptoms including fever (94%), hepatitis (75%), bone marrow suppression (56%) and gastrointestinal symptoms (56%). All except one were treated with antiviral therapy. Despite having similar baseline Charlson comorbidity scores, cases were more likely to return to surgery within 3 months (odds ratio, OR 6.31; 95% CI, 1.29–30.74), require renal replacement therapy (OR 18.54, 2.36–145.6), total parenteral nutrition (OR 33.0, 6.60–262.37) and corticosteroids (OR 18.78, 4.5–103.9). Length of stay was increased (median 51 vs. 8 days, P = 0.005), coinfections were more common (OR 15.10, 1.89–120.8), and in-hospital mortality was significantly higher (38% vs. 0%, P < 0.01).ConclusionReactivation of CMV occurs in nonimmunocompromised patients post-operatively and is associated with poor outcomes including other infections and mortality. Potential risk factors include prolonged length of stay, development of surgical complications, and prolonged use of corticosteroids. It is not clear from our study if CMV reactivation is a surrogate marker of severe illness and postoperative complications, or if CMV reactivation plays a causative role in the development of these adverse outcomes.Disclosures D. Snydman, Merck: Board Member, Consulting fee and Grant recipient. Shire: Board Member, Consulting fee. Takeda: Board Member, Consulting fee. Chimerix: Board Member, Consulting fee. Seres Therapeutics: Grant Investigator, Grant recipient. Actelion: Grant Investigator, Grant recipient. Moderna: Board Member, Consulting fee. Summit: Grant Investigator, Grant recipient. Tetraphase: Grant Investigator, Grant recipient.