Publication date: Jul 22, 2025

We aimed to evaluate whether cytomegalovirus (CMV) reactivation affects the length of stay (LOS) and mortality of critically ill patients with coronavirus disease 2019 (COVID-19) following standard steroid and anti-cytokine treatments. Retrospective data analysis of an observational cohort study. We included all inpatients aged ≥ 20 years with severe acute respiratory syndrome coronavirus 2 infection in Northern Taiwan between May and July 2021. Blood, sputum, or endotracheal aspirate samples were collected weekly from critically ill patients with COVID-19 who did not respond to steroid treatment and sent for CMV reverse transcriptase-polymerase chain reaction testing. We investigated whether there were differences in comorbidities and prognoses between patients who tested positive for CMV and those who tested negative. Of the 167 inpatients with COVID-19, 43. 3% (13/30) were critically ill, refractory to steroid treatment, and had CMV reactivation. Most (69. 2%, 9/13) patients with CMV DNAemia had concurrent CMV positivity in the tracheal aspirate. Compared with CMV-negative patients, CMV-positive patients had a longer LOS but not higher 14- and 28-day mortality rates. A high proportion of critically ill patients with COVID-19 who were refractory to steroid treatment developed CMV DNAemia. In critically ill patients with COVID-19, CMV reactivation can prolong hospitalization.

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