Laird Harrison

September 25, 2012

September 25, 2012 (San Francisco, California) — An automated monitoring system for cytomegalovirus can slash the rate of serious cytomegalovirus infections, researchers reported here at the 52nd Interscience Conference on Antimicrobial Agents and Chemotherapy.

A monitoring program at Copenhagen University Hospital in Denmark cut hospital readmissions due to cytomegalovirus infection in solid organ transplant patients from 52% to 13%, reported Caspar da Cunha-Bang, MD, an infectious disease specialist at the hospital.

Cytomegalovirus infections are not only common but dangerous in transplant patients, Dr. da Cunha-Bang told Medscape Medical News. "All the patients are immunosuppressed, so they are at greater risk of infection," he said.

"If you leave an infection for long enough it can cause damage an organ. If you don't do anything about it, then the [ultimate] consequence is that the patients die."

Copenhagen University Hospital has monitored cytomegalovirus infection in transplant patients for years, but the different departments in the hospital did not coordinate their efforts, Dr. da Cunha-Bang explained. "Before, it was not done as systematically," he said.

MATCH Program

When the new MATCH program was implemented, laboratories screened blood from the donor and the recipient for the virus at the time of transplantation. The results were automatically fed into a database.

The system uses an algorithm to assign patients to risk categories. It generates recommendations for further monitoring and, where appropriate, chemoprophylaxis.

Clinicians receive these recommendations and enter the patient's status in the database. The system then automatically updates its recommendations using this information and continuous assessment of viral analyses.

If data are missing or a virus analysis shows an abnormal finding, the system generates an electronic alarm.

A steering committee, with representatives from all the stakeholders, oversees the program.

To evaluate the effectiveness of the MATCH program, Dr. da Cunha-Bang and colleagues tracked patients with cytomegalovirus for the 2 years before the implementation of the program (2007 and 2008), the 2 years during implementation (2009 and 2010), and the year after it was implemented (2011).

The incidence of cytomegalovirus infection remained statistically constant, at about 18%, over this time period (P = .3), but the prevalence of moderate and severe infections decreased.

After 2 consecutive cytomegalovirus polymerase chain reaction assays finding more than 300 copies/mL of the virus, a patient was considered to be infected. In a mild infection, there were less than 10,000 copies/mL; in a moderate infection, there were 10,000 to 29,999 copies/mL; and in a severe infection, there were more than 30,000 copies.

In 2007 and 2008, 49% of those diagnosed with a cytomegalovirus infection had a moderate or severe infection. In 2009 and 2010, 41% had a moderate or severe infection. In 2011, after MATCH was implemented, only 10% had a moderate or severe infection.

The rate of hospital readmission due to cytomegalovirus infection went from 44% in 2007 and 2008, to 52% in 2009 and 2010, to 13% in 2011.

Even after adjustment for various factors, the improvement in moderate to severe infection from 2007 and 2008 to 2011 remained significantly associated with calendar time and donor/recipient immunoglobulin (Ig)G match (P < .0001 for both).

The improvement in hospital readmission rates from 2007 and 2008 to 2011 remained significantly associated with severity of infection at the time of diagnosis (P < .0001), calendar time (P =. 003), and donor/recipient IgG match (= .014).

There was no reduction in mortality, Dr. da Cunha-Bang said, although he did not present those data.

Monitoring: An Important Step

Asked to comment on the study, Bruno Ledergerber, PhD, a clinical epidemiologist at University Hospital Zürich in Switzerland, told Medscape Medical News that he is impressed with the results.

The improvement in monitoring is an important development in transplant infection control, said Dr. Ledergerber, who was not involved in this study. "It certainly sends a message, especially to surgeons, to collaborate with infectious disease specialists."

Dr. Ledergerber said his hospital has also improved its monitoring for cytomegalovirus. "But it's likely that it has not been done in such a rigorous way in many hospitals."

Dr. da Cunha-Bang and Dr. Ledergerber have disclosed no relevant financial relationships.

52nd Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC). Abstract T-369a. Presented September 9, 2012.

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