Pneumologie 2025; 79(S 01): S97
DOI: 10.1055/s-0045-1804755
Abstracts
D1 – Infektiologie und Tuberkulose

Diagnosis of Cytomegalovirus in BALF of immunocompromised patients with LRTI and its association to outcome

Authors

  • T Zouvani

    1   Clinic of Pneumology, Medical Center – University of Freiburg; Pneumologie

  • M Karakioulaki

    2   Clinic of Pneumology, Medical Center – University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany

  • K Jahn

    3   University Hospital Basel; Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital; Clinic of Pulmonary Medicine and Respiratory Cell Research

  • L Grize

    4   Clinic of Pneumology, Medical Center – University of Freiburg

  • E Papakonstantinou

    5   Department of Pneumology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany.; Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, 4031 Basel, Switzerland.

  • H Hengel

    6   Institute for Virology; University Medical Center Freiburg

  • K leuzinger

    7   University Hospital Basel; Clinical Virology, Laboratory Medicine, University Hospital Basel

  • H Hirsch

    8   University Hospital Basel; Clinical Virology, Laboratory Medicine, University Hospital Basel; Infectious Diseases & Hospital Epidemiology, Department of Acute Medicine, Clinical Virology, Laboratory Medicine, Transplantation & Clinical Virology, Department Biomedicine

  • D Stolz

    9   Universitätsklinikum Freiburg; Klinik für Pneumologie, Department Innere Medizin, Medizinische Fakultät, Albert Ludwigs Universität, Freiburg, Deutschland; Clinic of Respiratory Medicine and Pulmonary Cell Research
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Background: This study aimed to evaluate the impact of lower respiratory tract infections (LRTIs) caused by CMV, as diagnosed through polymerase chain reaction (PCR) testing of bronchoalveolar lavage fluid (BALF).

Methods: 2,666 visits involving 1,301 immunocompromised patients with symptoms of LRTI underwent diagnostic BAL, with 235 cases testing PCR positive for CMV in BALF. Main diagnosis were haematological (n=88), solid organ transplantation (n=70), and other forms of immunosuppression (n=77). The primary composite outcome encompassed predefined modifications in patient management within 30 days following bronchoscopy.

Results: Overall 59 cases exhibited isolated CMV infection, while 176 displayed coinfections. Isolated CMV infection was associated with more macrophages in BALF (75.5%, CI: 44.0 – 85.0). Coinfection was associated with neutrophilia in BALF (haematological 23.25% CI: 4.25-67.0; others 35.00%, CI 10.0-65.00). BAL findings prompted treatment modifications in 61.7% (n=145) of all CMV-BALF positive cases. The 30-day mortality rate stood at 13.6%, with a significantly elevated hazard ratio for those with CMV-positive BAL PCR diagnosis (unadjusted HR 2.85, 95%CI: 1.86-4.36,).

Conclusion: This study underscores the pivotal role of bronchoscopy with BAL in altering the management of immunocompromised patients with CMV-related infections, with mortality risk nearly tripling in patients with a positive CMV PCR in BAL fluid.



Publication History

Article published online:
18 March 2025

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